This article, about the Children’s Health Defense lawsuit against the American Academy of Pediatrics, was written by Dorit Rubinstein Reiss, Professor of Law at the University of California Law, San Francisco, who is a frequent contributor to this and many other websites, providing in-depth and intellectually stimulating articles about vaccines, medical issues, social policy, and the law.

Professor Reiss writes extensively about the social and legal aspects of vaccination in law journals. Reiss is also a member of the Parent Advisory Board of Voices for Vaccines. This parent-led organization supports and advocates for on-time vaccination and the reduction of vaccine-preventable diseases. She is also a member of the Vaccines Working Group on Ethics and Policy.

In January 2026, the anti-vaccine organization Children’s Health Defense (CHD) sued the American Academy of Pediatrics (AAP), claiming that the AAP’s decades-long effort to encourage immunizing children is a racketeering enterprise equivalent to tobacco companies’ decades-long efforts to mask the harms of tobacco. CHD claimed this violates the Racketeer Influenced and Corrupt Organizations Act (RICO), an act designed to target organized crime. Yes, you read that right. 

The case is titled Shaw v. AAP, after the lead plaintiff, Andrea Shaw, but because CHD brought the case and is leading it, I’ll focus on them. Andrea Shaw is a parent who lost her twin children and blames vaccines, though, as far as I know, the cause of death is not yet established, and the police are still investigating the deaths, and she was put as the lead plaintiff. 

The lawsuit is a tissue of strange conspiracy theories and false claims woven together to try to make a professional organization’s support for protecting children from disease sound like something nefarious. It treats AAP, pharmaceutical companies, Dr. Paul Offit, and the government as part of a large nebulous conspiracy, without distinguishing between the actions of each, and makes claims that are as legally spurious as they are factually unsound. 

While courts need to address claims objectively and seriously, this lawsuit really invites a Last Week Tonight episode or at least a Saturday Night Live skit. 

I think the AAP’s motion to dismiss, filed on April 3, 2026, captures the problem exactly when it says: 

This lawsuit is the latest missive in a campaign targeting the American Academy of Pediatrics and its use of science-backed evidence in vaccine policy. Summarizing the case exposes the absurdity and recklessness—not to mention the legal deficiencies—of its allegations.

In short, Plaintiffs allege that a non-profit organization dedicated to promoting children’s health—including by providing guidance about childhood vaccines—has perpetrated multiple criminal frauds as part of a wide-ranging and long-running criminal racketeering enterprise. That is because [CHD]… disagrees with decades of evidence-backed medicine and science and, unable to prevail through scientific discourse and debate, has instead chosen to weaponize the RICO statute to silence its opponents.

This post will explain what RICO is, the claims in the lawsuit, and some of the problems in the lawsuit. 

I will add that I strongly believe – and the references in the CHD lawsuit to AAP’s challenge to Kennedy’s vaccine policies reinforce it – that part of the motivation for the lawsuit is to target AAP over its effective opposition to Secretary Robert F. Kennedy Jr.’s efforts to undermine vaccines and vaccine uptake. But I also do think that part of it is a sincere belief by the anti-vaccine activists in CHD – who, as is true for most science deniers, are sincere in their belief in grand conspiracies – that AAP and pediatricians generally are part of a grand, nebulous conspiracy to harm people. 

What is RICO?

My student, Bella Baldeon-Volkov, prepared a wonderful summary of what the Racketeer Influenced and Corrupt Organizations Act (RICO) is:

RICO is a federal law that targets organized crime and racketeering. It enhanced existing criminal punishments while also creating new causes of action for acts done within an organized crime group. This law was originally passed in 1970 as a means to curb organized crime and allow victims of organized crime the chance to recover. Originally targeted at the mafia, this has not been the sole use of RICO. The law imposes a maximum criminal penalty of 20 years in prison for violating the statute. A pattern of racketeering is necessary for conviction under RICO. This translates into at least 2 separate racketeering acts needing to occur within 10 years of each other. Under RICO, a private individual who was injured by violating this law can recover treble damages.

To win a case under RICO, you need to show several elements: (I’m paraphrasing to match it to the lawsuit)

1. An enterprise. 
2. That committed a pattern – two or more over ten years – 
3. Of predicate acts, i.e., federal or state offenses of specific kinds. In this specific complaint, the alleged criminal acts are repeated instances of mail and wire fraud – AAP is accused of creating a false consensus around vaccine safety that “made actual research seem unnecessary,” and the complaint claims that “AAP has disseminated this fraud through mail and wire.
4. In which the defendant “actively participated” or conducted.
5. With intent to defraud.
6. That directly caused a concrete financial loss to the plaintiff. 

Children’s Health Defense Lawsuit

The lawsuit was filed in the name of three parents, two doctors, and CHD as an association, although, as pointed out in the motion to dismiss, to qualify for what is called associational standing, CHD had to show specific harm to at least one of its members, and it did not. This is probably fixable since I think Dr. Thomas is a CHD member, though I’m not sure. They had many other problems with the lawsuit. 

The parents include two parents alleging they lost children because of vaccines, and blaming AAP recommendations for their pediatrician’s recommendations to vaccinate. It’s horrible to lose a child, from vaccines or not.

I will not go into these claims since the issue with the complaint is the RICO claim, not whether there’s causation evidence for the death of the children. The third parent alleged that a medical consultant to her daughter’s school revoked her daughter’s medical exemption, based, allegedly, on allergic reactions to vaccines, and she was then vaccinated. This led, allegedly, to the daughter’s developing “hives covering her back and chest, then progressive joint stiffness and difficulty walking, exacerbating a prior vaccine injury. She was eventually diagnosed with a torn meniscus in four places and a stress fracture in her foot”.

It’s certainly possible that the doctor was wrong to revoke the medical exemption (some of the details in the complaint are questionable, and there’s just not enough to know what’s going on), but that is a strange thing to lay at the feet of AAP (and on its face, blaming vaccines for a torn meniscus and stress fracture seems strange, too). A severe allergic reaction is a situation where AAP recommends not giving that vaccine. 

The other two plaintiffs are doctors who lost their licenses, and they allege it was because they did not follow AAP guidelines. I have written about both before. Dr. Paul Thomas lost his license over repeating acts of negligent care, some of which involved children who got preventable diseases, others that did not, and the pattern is one of repeated lack of testing and creative treatment. Dr. Kenneth Stoller lost his license for writing fake medical exemptions. As the motion to dismiss points out, connecting these harms to anything AAP did or did not do is tenuous.

In addition, the harms these plaintiffs suffered also occurred, for all of them, before June 2025, when Kennedy changed the composition of ACIP. In other words, they occurred at a time that AAP’s recommendations paralleled ACIP recommendations and its statements on vaccines paralleled CDC’s. Trying to claim AAP’s actions were fraudulent and part of a nefarious enterprise when they were in line with expert government guidance is one issue, but showing a causal connection between any harm plaintiffs suffered and AAP (but not the government) actions, in these circumstances, would be… tricky.

What are the claims of the plaintiffs? They accuse the AAP of the following alleged “fraud” that AAP then distributed via wired and mail: (Note: this is a summary of CHD’s highly misleading claims. I follow with an explanation of how they are misleading).

1. In 2002 Pediatrics, AAP’s journal, published an article by Dr. Paul Offit (and other authors), who they describe as an AAP spokesperson, titled “Addressing Parents’ Concerns: Do Multiple Vaccines Overwhelm or Weaken the Infant’s Immune System?” in which the authors calculated the immune system’s capacity, concluding that “each infant would have the theoretical capacity to respond to about 10,000 vaccines at any one time.” This article, CHD alleges, was “a fraud”, “using the trappings of science to deceive parents.” CHD said parents were worried about the amounts of ingredients in vaccines. Still, the article deflected from that and made the question of how many vaccines children get “illegitimate,” ending scientific inquiry into the issue. They allege that this meant that contraindications to other additional vaccines were no longer studied, since “[i]f infants can theoretically handle 10,000 vaccines, then there is no biological basis for expanded contraindications regardless of how many vaccines are added to the schedule.” Then, allegedly, AAP gave this to its members to deliver to parents “in examination rooms across America.” 
2. AAP stated vaccines are safe and effective without informing people that in 2002 and 2013, the Institute of Medicine (IOM) mentioned that there was no detailed study of vaccinated v. unvaccinated. And, alleges CHD, the studies IOM called for were not done because of Dr. Offit’s article, which they attribute to AAP. 
3. Additional statements by Dr. Offit about Hepatitis B vaccines: CHD stated that he “appeared on CNN and PBS and stated that before universal infant vaccination, “30,000 children under the age of 10” contracted hepatitis B annually,” and that this is fraud by AAP because “The causation chain is direct: Offit publishes theoretical reassurance to preempt safety concerns. AAP amplifies it as a scientific consensus answering the parents’ concerns.” Also, AAP officials called out that the decision to remove the Hepatitis B vaccine birth dose and routine recommendation would harm many kids. 
4. AAP did not publish or share studies that anti-vaccine activists like, and some of these studies, the ones that were actually published, were retracted from journals not controlled by AAP – because of “the enterprise”’s suppression efforts. Not, G-d forbid, because they were methodologically flawed.
5. Pharmaceutical companies buy companies treating conditions like eczema, autoimmune diseases, and inflammatory bowel disease, which CHD thinks vaccines cause, and that is evidence of the enterprise AAP belongs to has “a closed-loop revenue system across the enterprise. The vaccine serves as the customer acquisition mechanism. A child who develops eczema after vaccination with an enterprise participant’s vaccine becomes a customer for another participant’s eczema treatment. A child who develops an autoimmune disease becomes a customer for the enterprise’s immunosuppressants. These are just a few of many examples. The enterprise profits from the vaccines, and profits again from the treatment of the vaccine package insert’s documented side effects.
6. AAP’s Red Book defines the standard of care for pediatricians, and those who deviate from it face discipline. AAP physician members are its “distribution network”, part of an enterprise that controls the information parents get about vaccines. 
7. Pediatricians are so financially dependent on vaccines that they cannot say no to the control of the enterprise. 
8. AAP calls those who disagree “misinformers” while spreading misinformation by, for example, saying vaccines don’t cause autism. This is even though Hannah Poling was compensated for vaccine-induced encephalopathy, and the CDC revised its website in 2025 to say that “The statement ‘Vaccines do not cause autism‘ is not an evidence-based claim because studies have not ruled out the possibility that infant vaccines cause autism.”
9. AAP criticized the administration’s January 2026 revision of the schedule, which limited the routine schedule to 11 diseases, and then, horror of horrors, announced it would publish its own schedule that deviates from the government’s and added the new action to its existing lawsuit, which by itself shows a criminal enterprise. 
10. AAP’s criticism is obviously fraudulent because California and Massachusetts require vaccines against fewer than 11 diseases for school. 
11. AAP points to VAERS and VSD as evidence of safety systems. This, alleges CHD, is fraudulent because in other contexts AAP explains that VAERS reports do not show causation and because VSD “is not a safety system. It is a database, a collection of electronic health records from eleven healthcare organizations covering approximately 12 million Americans,” and a study of vaccinated v. unvaccinated children that CHD thinks should have been done was not done.

All of this, says CHD, is exactly like the tobacco companies, which were found to have committed fraud because they knew cigarettes had risks and admitted it in internal documents but worked to hide it from the public. 

I set this out in probably more detail than the post needs to try to showcase how bizarre some of these allegations are. Remember, what the plaintiffs need to show is an enterprise between AAP and others to commit criminal acts – in this case, wire and mail fraud. Even before I go into the elements, I hope it’s clear that several of these are things that cannot, in any shape or form, be seen as fraud by AAP. 

An article in Pediatrics — a peer-reviewed journal — by a doctor that does not hold any official position would not be fraud by AAP even if it were untrue, and, as Dr. Matt Carey pointed out, nobody has yet shown the calculations in the article to be incorrect. CHD’s criticism that the article tries to deflect from parents’ concerns about ingredients is even less convincing since the article they’re using is part of a series about “Addressing Parents’ Concerns”, and in another installment in that series, Drs. Paul Offit and Rita Jew address vaccine ingredients. The article they attack is clear that this is a theoretical calculation about immune capacity, and the number of vaccines was – and is – a concern. In fact, on p. 33, the complaint uses that concern by referring to the anti-vaccine trope of “72+ dose schedule.” 

Further, Dr. Offit is an excellent communicator and a wonderful vaccine advocate on top of being a serious scientist and devoted doctor, but while, like most pediatricians, he’s a fellow of AAP, he does not hold a leadership role in it and is not their “spokesperson.” If and when AAP draws on his work, it’s because they agree with it. It’s not an “enterprise” just because a society of pediatricians likes the work of a doctor and scientist. Pediatrics is a peer-reviewed journal – the way these things work, AAP leadership won’t even know which articles they’re considering, and it is not the AAP’s newsletter – that’s here.

Similarly, pharmaceutical companies buying companies to treat medical conditions cannot be seen as fraud by AAP, even if we ignore the lack of evidence of a causal connection between several of the conditions mentioned and a vaccine. Not without showing some collaboration, which the complaint does not. CHD believing in a conspiracy is not proof of it. 

As to the IOM reports, not only is it not fraud, not to mention the specific quotes of the 2013 report (I admit I did not bother to go back and similarly check the 2002 report), but CHD very much misrepresented the report’s conclusion.

As the motion to dismiss reminds us, in 2013, the “IOM stated in that same paper that “[v]accines are among the most effective and safe public health interventions available to prevent serious disease and death” and that, notwithstanding the possibility of additional studies, “the available evidence is reassuring.” See Ex. 2 (IOM 2013)… also, in footnote 7, the motion reminds us that “The 2013 IOM Report in fact states that “[t]he committee’s efforts to identify priorities for recommended research studies did not reveal a base of evidence suggesting that the childhood immunization schedule is linked to autoimmune diseases, asthma, hypersensitivity, seizures or epilepsy, child developmental disorders, learning disorders or developmental disorders, or attention deficit or disruptive behavior because “perceptions dictate parental support and actions” it said that “further study of the full disorders”; thus, “there is no scientific evidence to justify the majority of safety concerns” and “no significant evidence to imply that the recommended immunization schedule is not safe.” However, immunization schedule as well as further study to understand stakeholder perceptions and how they are formed may help improve awareness and education efforts.” Ex. 2 at 135.” 

In fact, IOM did not even conclude that looking at groups of unvaccinated children is a good idea – here is what it said on that:

The committee also reviewed opportunities to study groups that choose not to vaccinate their children by use of a prospective cohort study design. However, such a study would not conclusively reveal differences in health outcomes between unimmunized and fully immunized children for two main reasons. First, the sample populations often suggested for study (such as some religious populations) may be too small to adequately power such a comparative analysis, particularly for very rare adverse health outcomes. Such a study would also need to account for the many confounding variables that separate these naturally occurring unimmunized populations from the average U.S. child, including lifestyle factors and genetic variables.

…

The Vaccine Safety Datalink (VSD) is a useful collaborative project that could conduct both postmarketing surveillance and longer-term targeted research.

In other words, the committee supported doing more work with VSD, and yes, more research with VSD was, in fact, done. CDC’s page about VSD has a list of such studies at the bottom. IOM did not ask for a specific study here.  

In other words, the IOM in 2013 did not contradict AAP’s conclusion that the schedule was safe and effective; it reaffirmed it. 

Further, pediatricians are not financially dependent on vaccines – in fact, vaccines present financial challenges to many pediatricians. 

So from the start, the factual scenario CHD is trying to draw is badly flawed. But that’s not all. 

Children’s Health Defense has not shown the elements of RICO

Let’s remind ourselves of the elements of RICO. To establish a RICO claim, you need to show:

1. An enterprise. 
2. That committed a pattern  – two or more – 
3. Of predicate acts, i.e., federal or state offenses of specific kinds. In this specific complaint, the alleged criminal acts are repeated instances of mail and wire fraud – AAP is accused of creating a false consensus around vaccine safety that “made actual research seem unnecessary,” and the complaint claims that “AAP has disseminated this fraud through mail and wire.
4. In which the defendant “actively participated” or conducted.
5. With intent to defraud.
6. That directly caused a concrete financial loss to the plaintiff. 

At this stage, before a decision on the motion to dismiss, fact-finding has not happened yet, and CHD’s claims need to be treated as if they’re true. But CHD does need to plead – state clearly in the complaint, with some factual support – the elements of the claim. They cannot make conclusory statements on the legal elements – just say they’re fulfilled – and call it a day; they actually need to make a case for each. CHD has not done that.

Enterprise

Remember that RICO is, in essence, focused on organized crime – and it is designed to capture conspiracies to do something, not just an organization doing something wrong for its own benefits. The “enterprise” requirement captures this – we are looking for some collaboration between the parties to the conspiracy. 

Enterprise is defined broadly for RICO: 

An “enterprise” is defined as including any individual, partnership, corporation, association, or other legal entity, and any union or group of individuals associated in fact although not a legal entity. 18 U.S.C.A. §  1961(4).

But there are limits to what would count as an enterprise. CHD claimed that:

AAP participates in an association-in-fact enterprise with vaccine manufacturers including Pfizer, Merck, GlaxoSmithKline, and Sanofi Pasteur), aligned entities such as the American Board of Pediatrics, and key spokespersons including members of AAP’s Committee on Infectious Diseases. The enterprise’s common purpose is to maintain and expand vaccine uptake by assuring pediatricians, hospitals, parents, and policymakers that the schedule is categorically safe, while concealing material facts about the lack of testing, inadequacies in the vaccine safety monitoring programs, and financial incentives tied to vaccine schedule compliance.”

However, the complaint actually does not show such an association. The fact that these different actors are doing things about vaccines does not, by itself, create an association. You need to show some collaboration related to the alleged criminal act between these different actors. It’s not there. 

The motion to dismiss points to a serious problem with this claim: to show an enterprise, the plaintiff needs to point to at least some decision-making structure in it, and CHD did not point to any such thing. They did not even try to allege how decisions are made. For example, of what you need to show, in United States v. Phillip Morris, the case CHD is trying to analogize from, the court found an enterprise when it found evidence of collaboration between different tobacco companies. The court found that they coordinated their actions, created a Tobacco Industry Research Committee, and more. CHD was not even claiming any specific coordination between AAP and its alleged collaborators. 

Further, an elephant in the room is the government, which had several structures to do its own research on the schedule (like IOM, monitoring systems, and more), and which paid, through the Vaccines for Children Program, for many vaccines. When the schedule AAP supported was also set by ACIP, which the CDC created, appointed, and had substantial control over, where is this alleged enterprise? CHD does not claim a conspiracy with the government. It tries to claim AAP controlled government through membership in ACIP, but as the motion to dismiss points out, “they don’t allege how the AAP or other enterprise participants were controlling vaccine policy while they served on a committee that the government controlled.”

A Pattern of Predicate Acts

CHD claims that AAP’s statements about vaccines, including saying that vaccines are safe and effective, denying that vaccines cause autism, and not mentioning CHD’s interpretation of the IOM reports, are fraud and that since AAP distributed those statements to its members, it committed wire and mail fraud. But describing any of these actions as crimes is unconvincing. As the motion to dismiss points out, disagreement is not fraud. Not mentioning things CHD believes is not fraud, either. It is even more reasonable not to mention articles retracted because of their shortcomings. 

CHD may sincerely believe (despite the evidence) that vaccines are not safe, not effective, and cause autism. AAP doesn’t have to agree with them, and pointing out that (like every scientific body in the world, all governments, and the United States government until Secretary Kennedy’s tenure) they see vaccines as safe and effective and conclude that vaccines do not cause autism is not fraud. 

This is especially a big problem for CHD because to plead fraud, there are higher requirements than for most claims, because fraud is a serious allegation. To plead fraud, CHD would have to show the “time, place and content of the false misrepresentations, the fact misrepresented, and what was retained or given up as a consequence of the fraud,” and allege specifically “which defendant caused what to be mailed [or transmitted by wire] and when and how each mailing [or wire] furthered the fraudulent scheme.” They don’t do that. 

Intent to defraud

To show intent, as explained in the motion to dismiss, plaintiffs need to “plead that the AAP made statements it “kn[ew] to be false or misleading,” MSP Recovery Claims, 728 F. Supp. 3d at 110. They must also plead ‘that money or property was an object of [the] fraud.’”

The motion to dismiss explains: 

…nowhere do they allege that the AAP knew this was false (in other words, that it knew the vaccine schedule was unsafe or ineffective). Plaintiffs “must offer some facts to support their claim” that the AAP “intended to deceive” its audience, but they have not done so. See Ambellu, 406 F. Supp. 3d at 80.

Plaintiffs try to claim that AAP knew of the IOM reports and that the studies they think should be done were not done, but that’s not the same as claiming that AAP knew vaccines were not safe and effective and said otherwise. They point to no evidence suggesting that. 

Further, while the complaint claimed that AAP’s motive was money – making more money off vaccines, without evidence, they do not connect the alleged wire and mail fraud to making money. AAP doesn’t directly make money off vaccines. It neither sells them nor has another direct connection. Who is it taking money from by claiming vaccines are safe and effective? Just saying “AAP wanted to make money off this” is too general, too conclusory, and not evidence of intending to defraud anyone of money. 

Conclusion

There are more points that the motion to dismiss challenges, but this is already long, and I hope the main point is clear: CHD believes that doctors, industry, and government are conspiring to hide vaccine harms for monetary gain and are willing to harm children along the way. These beliefs led them to use a law designed to capture organized crime, singling out as the main conspirator the American Academy of Pediatrics, an organization that represents doctors who specialize in treating children. 

Among the extreme anti-vaccine activists at CHD, using RICO makes sense; they may sincerely believe a criminal enterprise is involved. But to anyone else, these claims just don’t hold.  AAP’s statements and recommendations on vaccines for years tracked those of CDC and many other scientific groups and governments all around the world. The conspiracy claims require attributing to AAP the actions of other actors and do not show any collaboration between AAP and these other actors. The claims of fraud are, essentially, based on CHD’s core claims that vaccines are bad. It simply does not like AAP’s statements to the contrary.

Not agreeing with you, CHD, is not fraud and not a criminal conspiracy. That would be true even if your claims about vaccines were not blatantly wrong – and they are. 

This just doesn’t work, and any reasonable court would kick this extreme and strange complaint out.

This lawsuit should be dismissed.