Understanding the Vaccine Schedule Changes & New Doula Wins

My primary goal with ParentData is to provide you with the background and context for news and decisions. These days, that often means unpacking the news and announcements coming out of the CDC and the Department of Health under Robert F. Kennedy Jr. And nothing has been more confusing in my view than the situation with childhood vaccines. Things got even more chaotic when a judge recently overturned many of the changes that RFK Jr has made.

But what does that pushback even mean? Does it matter for your vaccine access? Is this just a temporary solution? What is even going on here?

This will not be the last you hear about this, so I wanted to take today to step back and remind us of the context, of what has already happened, and what might happen next.

Then, at the end, because we all need a little something good, some good news on doulas. If you’re tired of vaccines, just skip down there.

What’s going on with vaccines?

Traditionally (or at least, up until the current administration), routine childhood vaccination schedules have been set by the Advisory Committee on Immunization Practices (ACIP) and approved by the head of the CDC. These CDC vaccine schedules include recommendations for when vaccines for diseases like measles, polio, and pertussis should be given, and, until recently, these vaccine schedules were generally echoed by the American Academy of Pediatrics, individual provider offices, school districts, etc. These schedules also determine what vaccines will be covered under the Vaccines for Children program, which is the vaccination source for a lot of low-income children.

Until recently, this whole process was extremely uneventful. At their meetings, ACIP would review possible new vaccines, talk about approaches to unvaccinated individuals from other countries, and review the efficacy of seasonal vaccines. The presentations at these meetings were from career CDC scientists, and the committee members were generally doctors trained in relevant fields. To give you a sense, here is the agenda from the February 2024 meeting — it includes presentations on topics like “Guidance to use Td vaccine for those instances when receipt of the pertussis component is contraindicated.”

This isn’t to say that this committee doesn’t matter — they played an important role in COVID-19 vaccine recommendations, among other things — but generally, their changes moved slowly and barely made the news. Moreover, this committee has generally started from the assumption that vaccines are valuable, lifesaving interventions and their mandate is to figure out what the exact right approach is.

When Kennedy came in, he fired the existing ACIP members and replaced them with a smaller number of handpicked individuals. Many of these members seem to have been selected largely for their vaccine skepticism — especially about COVID-19. Not all were doctors. There were a few more traditional selections, like Dr. Cody Meissner, who had been on the committee before, but most were new.

With this committee, the tenor of the ACIP meetings changed. New votes were brought to reduce the vaccine schedule, including a removal of the recommendation for the hepatitis B vaccine at birth. These changes were made over the objections of some of the more traditional members of the committee (like Dr. Meissner), but these voices were outvoted.

Still, the speed of ACIP changes seemed like it was not enough for the health secretary, and in January, Kennedy announced a unilateral change to the vaccine schedule, which dramatically limited the number of universally recommended vaccines. This change did not go through ACIP; it was just announced directly. Under this schedule, a number of vaccines that had been universally recommended were moved to instead be based on “shared decision-making.”

These new guidelines got enormous pushback from groups like the American Academy of Pediatrics, who continue to recommend the old guidelines. Some (mostly blue) states moved to shore up insurance coverage of vaccines in their states, even if coverage is not mandated by the new federal guidelines. The AAP and others sued the administration to block the changes from taking effect.

Then, on March 15, a federal judge issued a ruling that effectively negated all of the vaccine-related changes that have been made under this administration. This includes the new vaccine schedule, all of the changes that ACIP made (like the change in the hepatitis B recommendation), and even the very composition of the committee. With this ruling, the changes revert — the new vaccine schedule is out, the changes to hepatitis B vaccine recommendations are rejected, etc. This has left the administration in limbo. ACIP did not meet as scheduled last week, and it is not clear that they will in the near future. Robert Malone, the vice chair of the committee, resigned on March 24. The government has said it will appeal the ruling, but has not yet.

Basically, it’s a gigantic, confusing mess.

So what does this all mean?

A very reasonable question to ask is does this matter? The short answer is yes, it does, but in ways that feel unpredictable. Where this lands may impact how some school districts think about vaccine mandates. Down the line, it could impact the timing of vaccine coverage under Medicaid or the Vaccines for Children program. There may be more state-level variation in vaccination rates and requirements, with some states mandating vaccine coverage and others not. All of this remains to be seen.

One thing that hasn’t changed: From an individual parent standpoint, you can still get all the vaccines you want (which, full disclosure, I hope you want all of them) on the normal schedule. This was true before, it has remained true, and it is true now. Even if RFK Jr’s revised vaccine schedule is upheld, it still makes it possible for people to get all of the vaccines.

Another thing that hasn’t changed: the impact of this entire discourse on trust. Vaccination rates have been declining for years and are continuing to decline. This is not about these ACIP decisions or who is on the committee — at least not directly. It’s about the landscape of mistrust that has been building for years. Reinstating the old vaccine schedule is the right thing to do from a scientific standpoint, but it is very unlikely to rebuild individual parental trust in vaccines. That is something that will take time and effort, neither of which the current leadership is interested in undertaking.

Some totally unrelated, palate-cleansing good news

Doulas are great. When people ask for my main pregnancy advice, this is the top of the list: get a doula. They are associated with all sorts of better birth outcomes, and those conclusions are based on high-quality data.

Doulas are also good policy. For insurers, it may actually make financial sense for them to pay for universal doula coverage because the cost savings from (for example) reduced C-section rates are sufficiently large to offset. Basically, this policy is a no-brainer.

Within the past few years, Medicaid has begun to wake up to this reality. About half of states provide doula services through Medicaid — here’s an interview I did with NY State Senator Samra Brouk on how she got this policy done there.

And now UnitedHealthcare has announced their employer-sponsored insurance plans will begin to cover doula care. This feels like a tipping point: where one large insurer goes, so do others (usually), and where one state Medicaid program goes, often others follow. I am hoping we are looking at the beginning of universal doula coverage, which would be great for parents, babies, and, yes, the bottom line.