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Donald Trump and vaccines – should we really worry?

Yesterday, we were all focused on the huge kerfuffle with Robert F Kennedy Jr, who may or may not have been asked to chair a vaccine safety panel. But, as we’ve shown before, when it comes to Donald Trump and vaccines, it is clear where the president-elect stands – on the anti-vaccine side.

Despite the consternation with Trump’s views on vaccines, we really should examine what he can and cannot do. Because other than the tweeting out his opinions about vaccines, which constitutes modern politics’ bully pulpit, what powers does Trump really have to modify or eliminate vaccines. The answer is somewhat complicated.

Donald Trump and vaccines – what he can’t do

Trump cannot force changes of vaccine requirements, since most are established at the state level. The CDC, a Federal agency, makes recommendations on which vaccines to use and the schedule for those vaccines. State health departments are in charge of modifying and implementing those recommendations.

Moreover, states have a wide variety of rules regarding vaccine requirements. For example, California’s SB 277, which makes vaccination mandatory (with limited medical exemptions) for all students entering school, is one of the strongest in the nation. It eliminated personal belief exemptions, that is, exemptions to vaccine rules based on some belief, rather than medical need. But other states have almost laughable vaccine requirements that allow almost any parent to get an exemption for their child.

Donald Trump has almost no ability to overrule these requirements, since they are the responsibility of the individual states. And frankly, more states are considering stiffening mandatory vaccination rules rather than weakening them, as we observe more and more outbreaks of vaccine preventable diseases resulting from unvaccinated children.

As for the vaccination schedule, the President simply has little to now power to change them through executive fiat. In the USA, the Advisory Committee on Immunization Practices (ACIP), members of which are appointed through a rigorous nomination process through the CDC, develops written recommendations for preventing diseases through vaccines. The President does not appoint ACIP members; in fact, they are selected based on scientific expertise in areas critical to vaccines, like immunology and epidemiology.

Clearly, when it comes to Donald Trump and vaccines, he has little ability to make any fundamental change to what vaccines are recommended and what schedule is required. Maybe we can relax, just a bit, about Trump’s pronouncements on vaccines, along with his bromances with Andrew Wakefield and Robert F Kennedy Jr.


What he can do

Notwithstanding what I wrote above, Trump does have a lot of power to influence vaccines. First, as we mentioned, he does have that bully pulpit, which gives him the ability to influence the conversation more than most other people. His minions voters, who obviously aren’t necessarily the most skilled critical thinkers, buy into almost everything he says. So if he says vaccines cause autism (remember, it doesn’t), who knows how many of his Twitter followers will accept that as a fact and quit vaccinating their children. That’s troubling.

Moreover, Trump will have extraordinary influence over public health since he appoints the Surgeon General of the United States, who is the head of the US Public Health Service, and as such, is the leading spokesman for public health. Trump will also get to appoint the director of the Centers for Disease Control and Prevention (CDC), who will have authority over the scientific research on vaccines. This is an incredible amount of influence, but not as much as you think.

The CDC doesn’t focus on vaccines exclusively, but on all diseases, infectious and otherwise. Though I have no faith that Donald Trump has any ability to choose a qualified person, generally, the Surgeon General and the Director of the CDC are not political positions – they are generally appointed for their backgrounds in healthcare as long as they fit with the overall political position of the President. But Trump may not care, and choose Andrew Wakefield as Surgeon General. Now there’s a nightmare.

Well, there’s another nightmare. Through the power of Executive Orders, which have the full force of law. I suppose Donald Trump could issue an executive order to end the ACIP, and that he alone decides what the vaccine schedule is. Ridiculous sure. But improbable? I’m not so sure. Of course, such an executive order will be subject to judicial review, and not being a constitutional attorney, I cannot determine if he can actually do this.

California is mostly immune (sorry) from the worst aspects of Trump’s rhetoric about vaccines. The state has a rather rigorous vaccine mandate (as long as you want your kids to go to school), and a well staffed and funded public health department. Many other states are in the same position – they’d just ignore anything that Trump tries to do with respect to vaccines. They’d prefer protecting children over listening to Trump’s anti-science ramblings about vaccines.

I wrote this article assuming I’d allay my fears about what Trump can really do about vaccines. I thought, when all was said and done, it was nothing much.

Life’s but a walking shadow, a poor player
That struts and frets his hour upon the stage
And then is heard no more. It is a tale
Told by an idiot, full of sound and fury
Signifying nothing.

Then I read what I was writing. I remain concerned that with respect to Donald Trump and vaccines – maybe we should worry.


Michael Simpson
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