Still fixated on the unproved theory that vaccines are linked to autism, last week – for the third time in less than a year – President Donald Trump inked yet another executive order, this time calling for children to be routinely immunised against fewer diseases, as they are in countries like Denmark, reports The New York Times.
It is not clear if the order has any legal power. In the US, vaccine recommendations are made by a committee of experts who advise the Centres for Disease Control and Prevention. These would then be adopted by the agency’s director. But only states can require vaccinations for children to enter school or day care.
The latest version is a revised schedule recommending immunising children against 11 diseases, rather than the 17 currently recommended by the CDC. It also “directs the Attorney-General to advance legal challenges against states that violate children’s rights to religious or medical vaccination exemptions”.
A previous effort to implement a shorter vaccination schedule was frozen by a federal court. That ruling is part of a continuing lawsuit brought by medical organisations arguing that the administration did not follow proper procedure and had made “arbitrary and capricious” decisions.
A judge agreed, saying the government had bypassed the careful, evidence-based practice that has traditionally underpinned vaccine recommendations.
“This is not likely to address the court’s concern, and is not a legally valid way to fill the statutory requirements about vaccine recommendations,” said Dorit Reiss, an expert on vaccine policy and law at the University of California College of the Law, San Francisco.
The President cannot legally circumvent the Advisory Committee on Immunisation Practices, which is empowered by Congress to make vaccine recommendations, and attempts to enforce the order will probably run into the same legal challenges, she said.
“There’s no science behind these recommendations,” said Dr Michael Osterholm, who directs the Centre for Infectious Disease Research and Policy at the University of Minnesota. “It’s all about ideology.”
The order signals the administration’s continuing obsession with the theory that some childhood vaccines may cause more harm than good, and that American children get too many shots. It also seemingly contradicts reports that the White House has urged Health Secretary Robert F. Kennedy Jr to shift his focus away from vaccines and toward diet and other issues less likely to alienate voters.
Trump championed some vaccines during the signing, calling the polio vaccine “amazing”, but also saying there were outstanding questions about other shots: he also suggested children get their shots in five separate visits for vaccines rather than all on the same day.
Kennedy said officials planned to deliver on the order earlier than the 90 days directed by Trump
The primary effect will be to sow more doubt and confusion about vaccines among parents, said Dr Andrew Racine, president of the American Academy of Paediatrics.
The executive order emphasises parental consent, stating that federal programmes should support “maximal parental choice”. Paediatricians are already required by law to provide information about the benefits and risks of vaccines before administering the shots. And states require vaccinations for school because decades of research have shown that this is an effective way to protect communities from vaccine-preventable diseases.
“Nothing bad can happen from what we’re doing,” Trump said at the signing.
But Dr Amesh Adalja, an infectious disease physician and senior scholar at the Johns Hopkins Centre for Health Security, said that harm was “inherent” in the order, because ignoring evidence-based vaccine recommendations would lead to more children getting sick.
The executive order recommends splitting the vaccines for measles, mumps and rubella into individual shots, rather than administering them in combination. “Together, there could be a possibility they’re quite lethal, and separately, it looks like they are not at all lethal, but just very effective,” Trump claimed.
He compared the volume of shots given to children to “the size of a bottle of soda” and “vats of vaccine”. But most shots contain no more than one-tenth of a teaspoon.
The order also urges officials to explore alternatives to aluminium, which has been added to vaccines for decades to strengthen the body’s immune response. Kennedy has frequently questioned the safety of aluminium as an additive, despite studies showing it is safe.
Kennedy said American children get 72 – or even up to 94 – shots. In fact, even including vaccines that are recommended and not required, such as a yearly flu shot, children may receive as many as 35 shots by age five.
The new executive order echoes the abbreviated vaccine schedule introduced by Kennedy in January. It recommends all children be immunised against only 11 diseases, including measles, mumps, rubella, polio and chickenpox, aligning the schedule with that of Denmark’s.
But it only recommends other vaccines, including shots against respiratory syncytial virus, hepatitis A and hepatitis B, for certain high-risk groups. (The order does not specify what constitutes high risk, but the revised schedule released in January outlined the criteria.)
For those not at risk, the new order recommends that some shots be given only when accompanied by “shared decision-making” conversations between doctors and parents. Those shots include vaccines against Covid-19, the flu, rotavirus, meningococcal disease, hepatitis A and hepatitis B.
Trump said the order “finally aligns the United States with other advanced and developed nations around the world”. Although the schedule mimics that of Denmark, it is a country with a small population and universal healthcare. Denmark also recommends fewer shots than many of its European peers, including other Nordic nations.
While the United States is on the higher end in the number of vaccinations it recommends, its schedule is closely aligned with those of Canada, Britain, Australia and Germany.
In the months since the government’s attempt to upend the childhood vaccine schedule, the American Academy of Paediatrics has released its own vaccination schedule, urging parents to ensure their children receive the previously recommended shots.
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