Illinois public health officials, pediatricians and experts who study vaccine policy are making preparations for President-elect Donald Trump’s administration to take office, after some of his top advisers and appointees have cast doubt on vaccines.
Trump’s pick to lead the U.S. Department of Health and Human Services, Robert F. Kennedy Jr., who is skeptical of vaccines, could potentially wield a lot of power over access to everything from measles to polio shots — diseases that can be debilitating and lethal.
Health and Human Services is a vast agency at the top of a pyramid of others that regulate food and medicine, when children should start getting vaccinated and for which diseases, along with public health insurance for the poorest and oldest people in America.
Here are four key takeaways about how medical professionals in the state plan to deal with vaccine policy, misinformation and what is likely to stay the same.
What Kennedy and the federal government could — and couldn’t — change
A key decision lies with states: vaccination requirements for school. Jen Kates, senior vice president and director of global health and HIV policy at the nonprofit health policy research organization KFF, said the federal government can’t mandate that states require vaccines or remove requirements states have.
Illinois requires a host of vaccines for children in day care through high school to protect against spreading measles, whooping cough and other diseases. Other vaccines are recommended, like the flu shot. Parents can request an exemption, and in the 2023–2024 school year, an estimated 2% of kindergartners in Illinois had a religious or nonmedical exemption — one of the lower rates in the U.S., according to KFF.
But here’s where federal influence can trickle down to the doctor’s office: The Food and Drug Administration, which is housed within HHS, has leeway in deciding whether to approve a vaccine. The Centers for Disease Control and Prevention, another agency within HHS, recommends to the public who should get vaccinated, like suggesting you get an annual flu shot or COVID booster.
“If the CDC doesn’t recommend a vaccine, it’s hard to see how many people are going to go get it, let alone a doctor feeling comfortable saying they should,” Kates said.
An influential advisory board appointed by the head of HHS could recommend changing the schedule for when kids should get vaccinated. For example, in Illinois, kids are required to be immunized against roughly a dozen diseases for school, according to the state public health department.
“That schedule has been pretty fundamental to how most people determine when they should get vaccinated, or when their kids should get vaccinated,” Kates said.
Tweaking the schedule could have a domino effect, she said, signaling to vaccine manufacturers not to produce as much, and leaving people who want a certain vaccine struggling to get it.
Could vaccination rates fall?
Yes, said Kates. Vaccination rates among kindergartners across the country have been falling since the COVID-19 pandemic, she said, mainly because of parents claiming nonmedical exemptions.
That might get families who want vaccines thinking about moving to a state or a school where their children might be more protected, such as kids or family members who have chronic conditions, organ transplants or cancer, making them more susceptible to getting very sick.
“Where I think it could really play out is if people are starting to see, like, measles outbreaks in their community and going, ‘Wait a minute, why is this happening? Oh, no one’s getting vaccinated. This is putting my kid at risk. This is putting my baby at risk,’ ” Kates said. “Will they make decisions to leave? Will they make decisions to go get vaccinated? I think we’d have to see how far this went and how much it affected rates.”
Dr. Ravi Jhaveri, who is the division head of infectious diseases at Lurie Children’s Hospital in Chicago, a destination in the region for the sickest kids, sees a silver lining.
“I want to emphasize that it’s not like we’ve gone to zero,” Jhaveri said. “The vast majority of families want their vaccines. They expect their vaccines on time. And so, I think we should be careful about thinking that the system is all of a sudden going to stop. I think that people, no matter what state you’re in, won’t tolerate that kind of change.”
The fate of one of the biggest vaccination programs in the U.S.
The federal Vaccines for Children program, known as VFC, was born out of a measles outbreak that sickened thousands of people and killed hundreds in the late 1980s and early 1990s. This effort is a key way low-income and uninsured children are immunized across the U.S.
Vaccines can be expensive, costing more than $1,000 per child during the first year of their lives. The VFC program is free for families, which experts say erases a big hurdle for parents who might not be able to afford vaccines.
In 2022, VFC distributed more than 71 million doses of vaccines to providers across the country, according to the federal government.
Last year in Chicago, nearly 200,000 children were vaccinated through the program, with nearly 700,000 doses sent to providers, according to the city’s public health department.
Dr. Han Yu Stephanie Liou, director of pediatrics at Alivio Medical Center, which largely treats low-income immigrants on Chicago’s South and West sides, illustrates the significance of the program. She recalled a migrant family from Venezuela who showed up with their 6-year-old son. They brought his vaccine records in a Ziploc bag they carried across jungles and rivers to get to the U.S.
He wasn’t up to date on his vaccines because his family said they couldn’t afford them back home, Liou said. He needed eight vaccines to catch up.
“I just see the mom’s face kind of fall a little bit,” Liou said. “She was like, ‘Can we do maybe, like, one or two today?’”
Liou explained the boy would be at risk of catching a disease. Then she learned the mother was trying to figure out how much money she needed to save to pay for the vaccines.
“I was like, ‘I have great news for you. All of these are free.’ And she was like, ‘What?’ ” Liou recalled. The boy received six vaccines and came back about a month later for more. Now Liou said she tells families up front that vaccines are free.
“Now that I do it proactively, I just see their shoulders relax,” Liou said. “They’re not trying to negotiate. I’ve had virtually no people want to diminish the number of vaccines given at a time as soon as they know that they’re not paying per dose.”
For those who don’t believe the government should be providing shots for free, Liou makes the economic argument: Kids who get sick have to stay home from school. Their parents miss work. If they end up in the hospital, they might get a big bill, or taxpayers help cover the cost if the families don’t have insurance. The cycle continues if they spread their illness to others.
Liou said she is ordering extra vaccine doses to make sure she has enough as the White House changes hands. She and others said they’re worried the federal government could strip funding from the VCF program, even though experts say that would be tough and require Congress to do so.
In Chicago, the federal government funds the program 100%. That comes to about $50 million to $60 million a year for vaccine doses, which are distributed to doctors for their patients, and another $2 million to the city to manage the VFC program.
What’s the backup plan if the federal government cuts VFC funding? Providers could bill the Illinois Medicaid program, which is the public health insurance program for low-income people, said Maribel Chavez-Torres, Chicago deputy commissioner for the Bureau of Health Protection. But the state budget for the next fiscal year is already projected to have a more than $3 billion shortfall.
The Illinois Department of Public Health manages the VFC program for the rest of the state, which the feds covered with about $120 million last year, a spokesman said. The department declined an interview request but in a statement said the agency would “advocate for full federal funding for this critically important public health function.”
Amplifying misinformation
As parents and pediatricians wait to see who ultimately ends up as the nation’s health chief, part of the fear is the unknown, said Jennie Pinkwater, CEO of the Illinois chapter of the American Academy of Pediatrics. It’s also the possibility that vaccine skeptics would have major leadership positions and a national platform, she said. Kennedy has promoted conspiracy theories about vaccines and questioned their safety.
“Distrust in that whole health system that we’ve kind of created through the CDC and HHS is really feeding into people’s worst fears around the government,” Pinkwater said. “I am concerned about that message just being amplified, even if eventually proven to not be true, right?”
Dr. Jihad Shoshara sees this play out at his west suburban pediatric practice. He treats a number of children who, because of their medical conditions, can’t get the measles vaccine, for example. Their parents are worried about making sure their kids are safe at school, should more kids not get vaccinated.
He said his practice doesn’t abandon families who could but don’t want to vaccinate their children, but it does encourage them to find another practice, to protect his other young patients. Other practices do the same.
“I do worry that we may see an erosion of trust in the vaccines that are keeping us safe,” Shoshara said. “It’s very easy to watch a video on TikTok or to look at something on Insta and get your information from there. It takes time for me or other medical professionals to fully answer someone’s concerns, and we don’t always have the time to do that.”
WBEZ data reporter Amy Qin contributed.
Kristen Schorsch covers public health and Cook County for WBEZ.