We Got a Legal Win for Vaccines. But Chaos Is the Point.

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On Monday, a judge’s ruling delivered a blow to HHS Secretary Robert F. Kennedy Jr.’s overt attack on U.S. vaccine policy. Since taking office, Kennedy has, in essence, hijacked the CDC’s Advisory Committee on Immunization Practices (ACIP). A judicial stay earlier this week means that, for now, important changes Kennedy jammed through over the last year have been reversed, including:

• Sudden changes in the CDC’s COVID-19 vaccine recommendations (outside of the usual transparent process involving ACIP)
• Revisions to the pediatric vaccine schedule (which included eliminating the recommendation for routine administration of the hepatitis B vaccine birth dose)
• Kennedy’s ACIP member appointments were recalled (they didn’t genuinely go through the legally required vetting)

Because ACIP’s voting members have now been benched, the meeting scheduled for this week has also been postponed. This is all good news, for obvious reasons. But there’s a larger problem…

Chaos Is the Point

Regardless of the final outcome (the Trump administration will likely appeal the decision), long-term damage has already been done. Because of President Trump’s executive orders and Kennedy’s policies, the CDC’s website is chaotically unreliable in the most confusing of ways. It’s neither reliably reliable nor reliably unreliable. It depends on the page.

So, how can the public tell which CDC webpages to believe and which to ignore? It’s not easy. It’s not like there’s any indication that the information on a page has (or has not) been tainted by Kennedy’s edicts. Yes, most of the pages are dated, so older pages remain accurate. But newly edited ones could either reflect data-driven updates from CDC scientists or reflect updates based on Trump-era nonsense. It often takes careful scrutiny to make the distinction — and people are on the CDC site looking for efficient answers.

It would actually be easier (though tragic), if I knew I could not refer patients to the CDC’s website. But I can’t abandon it entirely because so much of what’s there is really, really good. If you Google “lead poisoning,” “heart disease prevention,” or “smoking risks,” excellent CDC websites appear at the top of the search. But don’t Google “CDC, vaccines, and autism,” unless you want an ulcer.

I think that’s the point. Kennedy wants us to keep using the CDC site as a trusted source of information. He just wants some of the pages — his hobby horses — to reflect his warped view on vaccines. He wants genuine CDC expertise next to his drivel.

Even in light of the latest legal victory, the portion of the public that still believes in science (i.e., most of us, actually) is wary of the CDC now, thanks to Kennedy and Trump. As primary care physician Danielle Ofri, MD, PhD, wrote last year, the concept of medical expertise summarized simply by using the word “we” — that is “we recommend” — is now lost.

Now that the CDC’s website is no longer reliably reliable, the public has entered a medical information diaspora. The information is out there, but you have to seek it out, curate it, and vet it for yourself. Sometimes it’s challenging to distinguish a good resource from mediocre or even bad ones. That’s what made the pre-Trump 2.0 CDC website so great. In almost all instances, we knew that what we’d find was good.

For Kennedy and his allies, this is mission accomplished. Still, we must soldier on. This week’s legal victory is evidence that we can win.

Bonus Analysis

Some friends of Inside Medicine have already opined on all of this. Check these out:

• In “You Can Know Things,” Kristen Panthagani, MD, PhD, highlighted some key moments from the judge’s ruling. I found this brief piece to be informative and cathartic.
• New York Times: “Doctors Say Court Ruling Can’t Undo Kennedy’s Vaccine Damage,” by reporters Maggie Astor and Dani Blum, with quotes from my good friend Megan Ranney, MD, MPH (Dean of the Yale School of Public Health).
• MedPage Today published an opinion by Richard Hughes IV, JD, MPH, in which he argues why the legal process matters so much. This will factor into my discussion with Hughes in a forthcoming interview.

A version of this post originally appeared in Inside Medicine.