FLORA LICHTMAN: This is Science Friday. I’m Flora Lichtman. Coming up on the show, an amoeba that likes it hot and spreading bird joy with the Christmas Bird Count. But first, since 1955, when Congress passed the Polio Vaccination Assistance Act, the Federal Government has pretty much been in the business of expanding access to vaccines, that is, until this year.

2025 has been filled with almost daily news headlines about federal agencies under the direction of health Secretary Robert F Kennedy Jr. Casting doubt on vaccine safety while taking steps that could roll back access. So how do we out what’s just talk and what has teeth?

A year in, we are asking, what has this administration’s stance on vaccines meant practically, for vaccine access and vaccine uptake? Here to tell us more are two reporters from KFF Health News, the journalism arm of the nonprofit health research foundation KFF. Jackie Fortiér and Arthur Allen, welcome to Science Friday.

ARTHUR ALLEN: Thanks for having us.

JACKIE FORTIÉR: Happy to be here.

FLORA LICHTMAN: Let’s start with the recent news on the hep B vaccine, Jackie. Just this week, the CDC ended its nearly 35-year recommendation that infants receive the vaccine for hepatitis B right after birth. What does this recommendation change mean in practice?

JACKIE FORTIÉR: It’s important to what hepatitis B is. So hepatitis B is a highly infectious virus that attacks the liver. It’s transmitted through contact with infected bodily fluids, including blood. It can also be passed from mother to baby in late pregnancy and during birth.

There is no cure for hepatitis B. It can scar the liver and cause liver failure and liver damage. So it can eventually kill you. That’s what we’re trying to prevent.

And there’s a three-dose vaccine that does an amazing job of preventing hepatitis B for decades. And also, if a baby is born with hepatitis B, it can actually make sure that that virus doesn’t spread, as long as it’s given within the first 12 hours of life.

FLORA LICHTMAN: OK, so the timing matters.

JACKIE FORTIÉR: Yes. Timing is very, very important, especially for babies born to mothers whose viral status is unknown, so if they don’t know if have hepatitis B or not. This changes the universal birth dose recommendation to a risk-based one and kind of reverts us to pre 1991.

The decision wasn’t really evidence based, and hepatitis B vaccine has one of these very well-established safety records of any vaccine. So as a consequence of this, there’s going to be more misinformation and I think more questioning of the hepatitis B vaccine, especially the birth dose.

FLORA LICHTMAN: So the insurance does still have to cover it, though?

JACKIE FORTIÉR: Yes, they do.

FLORA LICHTMAN: Does this mean that you have to ask for it now?

JACKIE FORTIÉR: Parents always had the choice of whether or not to give the birth dose of the hepatitis B vaccine. But it’s, I think, causing a lot more people to question that in a way that they didn’t before.

ARTHUR ALLEN: Right. You weren’t ever going to be not allowed to take your baby home if you didn’t get them vaccinated against hepatitis B. It was just recommended very strongly.

What I’ve heard is that 95% of hospitals that have been vaccinating routinely against hepatitis B are going to continue doing so. However, there may be some they may not offer it. They may only provide it when asked. And so most people aren’t going to know about hepatitis B vaccine at birth, and they may be alarmed by the idea of their baby getting a shot because they don’t really understand why. And that’s the biggest fear, I think.

FLORA LICHTMAN: Arthur, you’ve been covering this beat for decades. Can you put this change in context for us?

ARTHUR ALLEN: I just think that what’s happened is that the CDC has been turned on its head. The fringe is now in power. These are people who have been skeptical of vaccines, almost all of them on the ACIP, which is the Advisory Committee. Lots of leadership of FDA and others at HHS are very skeptical of vaccines. They attribute all kinds of risks to them. And whereas before, policy making on vaccines was based on actual risks and benefits seen in research, now what they’re doing is they’re fitting the policy to their belief system.

FLORA LICHTMAN: Hmm. Let’s talk about the COVID vaccine. The recommendations also changed this year. Can you walk us through how they’re different and how that’s changed whether people are getting access or taking the COVID vaccine?

ARTHUR ALLEN: It’s very complicated and confusing because–

JACKIE FORTIÉR: It’s incredibly complicated.

ARTHUR ALLEN: Yeah, and I think, in some ways, that’s the strongest point to make is that it’s really confusing. But if you’re determined to get a COVID vaccine, I think it might take some effort depending on where you’re living. But you probably can get it.

They are required to provide it. But I think it’s going to be harder to get, and there’s a lot of contradictory information. Kennedy has said that pregnant women and children shouldn’t get it. If you look at the CDC website, their latest update from two weeks ago says pregnant women should get it.

FLORA LICHTMAN: Really?

ARTHUR ALLEN: Yes. This is November 29 CDC guidance on COVID vaccine on who should get it. But that is part of the confusion. The

Other confusion is, of course, that the mainstream medical societies are all very strongly in favor of vaccination, usually at all ages. The biggest problem with getting COVID vaccine now is going to be because this climate of suspicion of the vaccine, plus the government’s action, plus the public’s just feeling like, phew, COVID is over, has reduced the demand so much that there are going to be some pharmacies, some doctor’s offices are just not going to carry it anymore because there’s not enough demand. And so they don’t want to buy a bunch of vaccine and have it just be thrown away after a couple of months.

JACKIE FORTIÉR: And that’s exactly the problem with pediatricians especially because younger children, babies, anyone over the age of six months can get vaccinated against COVID. And they recommend especially that children who have never had COVID get vaccinated against it because every year COVID puts children in the hospital, just like it does adults.

ARTHUR ALLEN: Right, a really good point, yeah.

JACKIE FORTIÉR: So it’s extremely difficult, I’ve been hearing anecdotally from people, to get their younger child vaccinated because a lot of people go to a pharmacy, CVS, Walgreens to get their vaccines. They don’t go to doctor’s offices too often.

That works fine if you have an older child or you’re an adult. It doesn’t work if you have a younger child because pharmacists can’t vaccinate babies and toddlers in most states. So that means that parents have to go and see a pediatrician if they want to get their child vaccinated.

And when they’re that age, it’s two to three doses of the vaccine over a period of months in order to get them fully vaccinated. But the COVID vaccine is expensive. It’s a lot more expensive than the flu vaccine for these pediatrician practices to buy.

And it doesn’t have a very long shelf life. The flu vaccine lasts for months, COVID not so much. And they don’t get reimbursed at a very high rate for the vaccines that go bad and they can’t use.

So it’s this conglomeration of people not being as interested in getting their kids vaccinated, which means the pediatricians see fewer people asking for it, so they don’t order as much of the vaccine. And then the vaccine is– or sometimes they just don’t carry it at all. And then the vaccine isn’t available. I heard about a couple that had to drive an hour and a half south of where I live because their pediatrician’s office just didn’t offer the COVID vaccine, and they wanted their seven-month-old vaccinated.

FLORA LICHTMAN: Hmm. Are there other changes that you have seen to vaccine access or uptake this year?

ARTHUR ALLEN: I’ve been reporting on one interesting development, which is kind of sad, which is that, in a lot of cities where the public health department offers back-to-school vaccination or catch up vaccination for older kids, the clinics are seeing about half as many as they did last year. And I don’t have demographic data, but my understanding is that some of it is CDC has not been advertising, go get vaccinated. And ICE raids and other fear of immigration are keeping Latino and some other immigrant populations away from public clinics to get vaccinated because they’re no longer protected from raids.

FLORA LICHTMAN: So ICE raids are preventing people from going to public health clinics to get vaccinated?

ARTHUR ALLEN: We don’t have solid proof of that. All we have is correlations of ICE raids in certain cities and then seeing dramatically declining rates of people showing up for these clinics. And it’s possible that these people are getting vaccinated elsewhere, but it seems clearly, anecdotally, to be one of the factors that’s really cut these vaccination rates at public health clinics down quite a bit.

JACKIE FORTIÉR: And also the COVID vaccine rate is down this year. It’s in the single digits for children, and older adults are not getting vaccinated. And 65 and older are especially vulnerable to being hospitalized or even dying from COVID, and their immune systems don’t remember the viruses as efficiently. So that’s really worrying.

ARTHUR ALLEN: Even really sick people with disabilities, the rate is falling, I’ve heard.

JACKIE FORTIÉR: Yeah, right. So if we have low vaccination coverage, we could be facing a more severe hospitalization season as winter transmission ramps up.

FLORA LICHTMAN: We have been inundated this year with headlines about this administration’s skepticism around vaccines and possible changes and possible rollbacks. Do you have tips for us on what we should really be paying attention to?

ARTHUR ALLEN: Well, I think it all needs to be paid attention to because the attack on vaccines, whether it affects you personally and your ability to get a vaccine, it’s going to affect all of our communities. Right now there’s measles swamping various places in the country, like Northern, part of South Carolina.

And we’ve had almost 2,000 cases at least this year. There’s a terrible whooping cough epidemic going on. Babies are dying.

And that affects who shows up at school. But concretely, Kennedy has said that he’s not taking vaccines away from anybody. And I think what he means– and I don’t know if this is going to be really hold true entirely. But I think what he means is they’ll say, the decision is up to you.

And under vaccine law, that means that insurance should cover these vaccines that are recommended to the extent of, get it if you want it. And so in theory, I think, at least so far, if you want a hepatitis B shot for your infant, your newborn, if you want to get a COVID vaccine, you can get it.

It’s just is it going to be available? And how bad do you want it? And in some cases, how much do you want to spend?

Insurance, so far, the voices that we’ve heard from the insurance industry have all said they are going to cover the vaccines pretty much the way they’ve been covered historically. But the devil’s in the details. We’ll see how it pans out.

FLORA LICHTMAN: Arthur Allen is a senior correspondent at KFF and author of Vaccine– the Controversial Story of Medicine’s Greatest Lifesaver. And Jackie Fortiér is a health policy reporter at KFF. Thank you to you both for joining me.

ARTHUR ALLEN: Thanks so much.

JACKIE FORTIÉR: Thank you.

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