Our Vaccine System Is Delicate. Trump Just Threw a Bowling Ball at It.

The vast majority of parents support vaccines and do not want their kids to get sick. But the new recommendations, and the misinformation they encounter from top U.S. health officials down through the information ecosystem of the internet, will lead to confusion. Similarly, nearly all providers understand the value of vaccines and want their patients to be protected, but they have limited time at medical visits to cut through all of the noise around vaccines—in addition to all of the other conversations that happen around growth and well-being and developmental milestones. “The more time that goes toward trying to address hypothetical concerns around vaccines that are unfounded, there’ll be less time to address all the other important issues that ought to be included in the well-child visits,” Schwartz said. As The Washington Post recently reported, providers may also need to deal with parents trying to get their kids vaccinated ahead of schedule because of the new worries about availability.

Some groups are trying to fill the gap left by federal guidance. The new Vaccine Integrity Project at the University of Minnesota conducts exhaustive reviews of the scientific evidence with which existing and highly respected medical organizations, like the American Academy of Pediatrics, may make recommendations. Researchers at the Yale School of Public Health, for instance, are developing a dashboard to survey outbreaks anywhere in the U.S. Some states are forming regional alliances, like the West Coast Health Alliance and the Northeast Public Health Collaborative, to preserve access to and recommendations for vaccines and more. Former top officials who were pushed out of U.S. health agencies are now landing at state and local health departments.

But increasingly, where you live may determine which vaccines you can get—and your overall risk based on others’ vaccination rates. Vaccine policies are set by states, and until now, states have relied on clear, evidence-based recommendations from the federal government, Hall said. “Now, what we’re seeing is essentially a lot of fragmentation happening.” The fragmentation and polarization are likely to worsen as red states feel financial and political pressure from the Trump administration to step in line. School vaccine mandates, which are set by state and local governments, are facing their greatest threat in generations, Schwartz said. “Your child’s risk of vaccine-preventable disease, on the one hand, will look different based on where you live and, in large part, on the political party in power,” he said. But those geographical differences can only go so far, Schwartz added: “As the old saying goes, infectious diseases don’t respect borders.”