Will You Be Able to Get a COVID Vaccine This Fall? That Depends on One Absurd Factor.

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Last week, US senators spent three hours in a hearing room grappling with an urgent problem. The problem is that even though most Americans trust vaccines and feel safer when they and their families have access to them, the Trump appointee in charge of distributing America's shots has his doubts.

This hearing was supposed to be about the president's plan to “make America healthy again.” But for Democrats, Robert F. Kennedy Jr.'s actions as the secretary of Health and Human Services changed the agenda. We've known from the beginning, of course, how Robert F. Kennedy feels about vaccines. But it's worth talking about what he's done . So far, he has fired members of a crucial vaccine advisory committee—something he promised senators he would not do. His Food and Drug Administration has tried to limit who can get COVID shots this fall. The secretary booted the head of the Centers for Disease Control and Prevention after a disagreement over immunization practices. Then, more than 1,000 government scientists demanded Kennedy's resignation.

We have a recent episode of What Next, Mary Harris spoke to Apoorva Mandavilli, a science and global health reporter at the New York Times, about how RFK Jr. put himself between Americans and their vaccines. This transcript has been edited and condensed for clarity.

Mary Harris: Some of the former members of the Advisory Committee on Immunization Practices who were fired to Stat News , and they said Americans are losing the ability to choose vaccination. I thought that was an interesting way of phrasing things, because it's not like your vaccine is being taken away. It's your choice to have a vaccine. Can you just lay out how this is working?

Apoorva Mandavilli: Their word choice, “choose to,” is also very important because that's what RFK Jr. has always said. He wants to give Americans a choice, and he believes they should be able to choose whether they want a vaccine or not.

But the FDA said from the start, as soon as the new leaders came on board, that they were not going to approve vaccines for anyone under 65 without new evidence. And sure enough, that is what has happened. They have approved the vaccine only for people who are older than 65 or for some people who have other health conditions that may put them at high risk. They're not approving them for healthy pregnant women.

RFK Jr.'s announcement in May that the CDC would no longer recommend the vaccines also means that insurance companies won't cover them. So now you have a situation where, let's say, there is a 50-year-old person who does not have any health conditions but wants to get the vaccine because they believe in it, and maybe they don't want to expose anyone else to it. Maybe they want it because the vaccine does provide benefits, and they don't want to get sick, or they don't want to end up in the hospital.

If we look at the example of the COVID vaccine, how is policy trickling down to actual access? These people will not be able to get the vaccine without finding a doctor who is willing to do that for them off-label, and they might have to pay for it out of pocket.

Some pharmacies, like CVS and Walgreens, give out tons of shots for adults. They're actually now saying that they won't carry the COVID vaccine at all in certain states because of what's going on. Even in states where you are, in theory, able to get it, the reality is that when you have these kinds of rules, pharmacies are just reluctant to carry the vaccine. They don't want to get involved in this kind of thing because it's just too difficult.

RFK Jr. has also threatened doctors who go against the guidelines, saying that they will not be protected from liability if they don't follow ACIP recommendations. That's a real unearth for any doctor.

How does it compare to worldwide policies?

One thing that a lot of the COVID vaccine skeptics point to is that the guidelines now are closer to what they are in other countries. Of course, they very conveniently leave out the fact that in those countries, the vaccine is still approved for everyone. So they do actually have a real choice. They can still get it if they want. And many of these countries have national health care. So they're not worried about the cost for themselves if they want the vaccine. The circumstances are very different, partly because they have a safety net. They have a health care network that takes care of them.

Last week, Florida came out and said it will no longer require vaccines to participate in public life, whether that means going to school or whatever else. This is striking because vaccine mandates have been around for a long time and have been controversial for a long time. But they're definitely a tool of public health to keep all kinds of people safe. So when you heard about what was happening in Florida, what was your reaction? And can you tell that story a little bit?

Florida has a surgeon general who has been very anti-vaccine for quite a while now. He said many, many things about COVID vaccines that are not true. Even when there was a measles outbreak, he said that kids could come into school without being vaccinated. It's not surprising that states are starting to go their own way. States have always decided for themselves what to do with various health policies. But what has been important for them is to have this central voice, the CDC, saying, “This is what we think is right,” and then they can just follow that. Maybe they make minor tweaks here and there, but they essentially follow that.

But when you have a situation where they can no longer trust government what's coming from the federal, then they are sort of forced to make their own decisions at a whole other level, where they have to actually review the evidence themselves or entrust their own judgment in a way that they haven't had to. That's when you see Florida saying, “Well, I'm trusting my judgment and I don't think anybody needs to be vaccinated to come to school.” But you're also seeing West Coast states—Washington, Oregon, and California—saying they're going to review the evidence on their own. We're hearing about Northeast states doing that. New York is apparently going to follow its own thing. So this mishmash was predictable when the CDC stops being the central voice that they all listen to.

Next week, when ACIP meets, are they going to give further guidance? And how do you think their guidance is going to be viewed, given the fact that RFK Jr. just showed up on the Hill and got beaten about the head by senators?

Insurance companies are still going to cover what ACIP recommends. And there are many states whose state-level recommendations are very tied up with ACIP. Their laws will say that they follow the ACIP guidelines pretty much as they are. So for anyone to break with those recommendations, it would require some work.

I wonder if we're going to see a future where people travel to get vaccines, where one state looks very different than another state, and what that will mean, because of course, we're all interconnected. States border each other. And so an outbreak in one place doesn't necessarily stay in one place, right?

It doesn't at all. It doesn't stay in one state, in one country. The thing to remember also is that a lot of the money that state health departments have come from the CDC. So when that budget is cut, which it has been, they have less money. And they had to lay people off. So at the same time that they're being asked to make more decisions on their own, or they're having to make decisions on their own, they have fewer people to do the work.

Vaccines are all about prevention, and you don't see the benefit of them for a really long time. You're preventing a negative. So when an outbreak does happen, it may happen years after the vaccines are no longer available. Would it then be harder to draw the connection of why it happened?

Yeah. Something public health people say a lot is, “When we're doing our job right, you don't see us.” So when we start to see more measles outbreaks, or polio, that's when it'll become clear what was needed.

It'll also become clearer how intricate this network is. Things go across states, across countries. So you can't dismantle global health, and you can't dismantle federal health structures, and still expect things to function OK at the local level. That's just not how it works.