This month, at an Oval Office event resounding with outlandish statements, President Trump signed an executive order called “Delivering Gold Standard Childhood Vaccine Recommendations for Americans.” His order cut the number of vaccines the federal government recommends for all children from seventeen to eleven. It threatened legal action against states that don’t grant expansive exemptions from vaccine mandates. And it proposed that the vaccine against measles, mumps, and rubella (M.M.R.), which is currently combined to curb costs and reduce the total number of injections that children receive, be separated into three different shots.
In his remarks, Trump repeated a debunked theory that vaccines are linked to rising autism rates. He claimed, incorrectly, that doctors were injecting doses “the size of a bottle of soda” into tiny bodies, and argued that the M.M.R. shot “can be explosive” and “quite lethal.” (M.M.R. vaccines have been administered hundreds of millions of times, and have contributed to saving millions of lives while causing meaningful side effects in only the tiniest minority of cases.) During the event, he made sure to thank “the man who has done more than perhaps anyone else to bring about this real revolution”—the Secretary of Health and Human Services, Robert F. Kennedy, Jr.
Trump’s executive order, which was not supported by any major independent medical organization, is perhaps the Administration’s most forthright attempt yet to upend federal vaccine recommendations. It has been touted as a major victory for R.F.K., Jr., whose time as Health Secretary has dismayed the public-health community. Under Kennedy, vaccine skeptics have been elevated to prominent positions and public-health agencies have suppressed the publication of scientific reports that diverge from his preferred narrative. (Officials have said that the reports were pulled owing to methodological concerns.) Parents are increasingly asking pediatricians to delay, space out, or altogether forgo immunizations for their children. State lawmakers have introduced hundreds of bills to weaken immunization rules and access, or to undermine trust in vaccines. There’s been a sharp uptick in the number of kindergarteners deemed exempt from such mandates; in some states, more than one in every eight remains unvaccinated against a preventable disease. Under the second Trump Administration, the United States has recorded more measles cases than it did in the preceding twenty-eight years.
It’s reasonable to worry that the R.F.K., Jr., era has set American science and medicine back in ways that might not be corrected for years, if ever. Yet it’s also possible to read Kennedy’s efforts, especially the new vaccine recommendations, less as triumphs than as flailing attempts to enact an unwelcome vision. Kennedy and his agenda are hardly popular. Public trust in the agencies he leads has fallen. The latest order, like prior attempts to undermine established vaccine guidance, will surely face legal challenges that limit its scope and impact.
Kennedy has argued that “there is no vaccine that is, you know, safe and effective,” and that the COVID shot was the “deadliest vaccine ever made.” But, as the nation’s top health official, he has struggled to actualize his maximalist rhetoric in the way that other Administration officials have theirs. Trump’s Department of Homeland Security says that it deported more than half a million people in the President’s first year back in office, sending some to countries they’ve never been to. The Department of Justice has launched pretextual prosecutions against the President’s political opponents. Elon Musk bragged about throwing U.S.A.I.D., an agency estimated to have saved millions of lives around the world, into a “wood chipper.” In the meantime, measles immunization rates among kindergarteners have fallen by less than one per cent. The share of kindergarteners with formal exemptions from vaccine mandates rose from 3.6 per cent to 4.2 per cent. These are troubling developments, to be sure, and enough to contribute to an unprecedented rise in infections. But, for now, we are not living in the worst-case scenarios that some envisioned when Kennedy took office. A year and a half into his tenure, is R.F.K., Jr., winning or losing?
A century ago, the Italian Marxist philosopher Antonio Gramsci was arrested and imprisoned for his opposition to Mussolini’s Fascist regime. In his “Prison Notebooks,” Gramsci continued to advocate for social change, but, fearing censorship, developed a metaphor based on the trench warfare of the First World War. Society, he argued, could be transformed through a “war of maneuver” or a “war of position.” A war of maneuver refers to the abrupt seizure of political control, such as Germany’s invasion of Belgium or the Bolshevik overthrow of the tsarist government in Russia. A war of position, in contrast, proceeds slowly, wielding what Gramsci called “cultural hegemony” to shape how people see the world. Wars of maneuver win territory; wars of position win hearts and minds.
In the American context, the civil-rights movement was arguably a war of position, and so was the fight for marriage equality. Both culminated in victorious maneuvers—transformative legislation, Supreme Court decisions that expanded rights—but they were preceded by decades of cultural change. In Gramsci’s telling, wars of maneuver could succeed where the state had a tight grip and the institutions of civil society (churches, schools, unions, professional organizations, the press) were weak and malleable, as in Imperial Russia. But in Western nations he perceived a more equal balance between the state and civil-society institutions. The government was “only an outer ditch,” Gramsci wrote, “behind which there stood a powerful system of fortresses and earthworks.” This meant that winning a war of maneuver, whether in a coup or in a transformative election, might not be enough to effect lasting change. Indeed, Italian Fascism toppled at the end of the Second World War.
Before R.F.K., Jr., became Health Secretary, he argued that “the people who run our vaccine programs should be in jail” and compared their work to that of Nazi death camps. He accused them of covering up mass harm to children, arguing that “the pedophilia scandal in the Catholic Church is a perfect metaphor.” He suggested that after some children are immunized, “three months later their brain is gone,” and that doctors giving vaccines have “butchered” children and “poisoned an entire generation.” He said that he would “do anything” to go back in time and not immunize his own children. When he became Health Secretary, he was determined to change the system that he had long criticized. He reportedly wanted to abolish the childhood-vaccine schedule and dedicate more than a tenth of the N.I.H. budget to studying supposed links between vaccines and autism. (An H.H.S. spokesperson contacted by Reuters disputed that Kennedy wanted to abolish the schedule; the N.I.H. proposal was eventually dropped.)
Kennedy certainly made news for his maneuvers. He eliminated a quarter of the H.H.S. workforce at the direction of DOGE, removed the heads of research institutes, dismantled programs that protect against environmental toxins and infectious diseases, and replaced the members of the Advisory Committee on Immunization Practices, a key C.D.C. vaccine-advisory group, with handpicked selections. But the net result was chaos, not coherent change. Kennedy’s mass layoffs, for instance, were carried out in such a haphazard fashion that he later described roughly twenty per cent of them as possible errors. He hadn’t meant to terminate a C.D.C. program dedicated to preventing lead poisoning in children, for example. “Personnel that should not have been cut were cut,” Kennedy said. Some of the fired employees have since been asked to return.
For all the damage that Kennedy has inflicted, his actions on vaccines have largely been piecemeal and procedural. He attempted to delay some infants’ first hepatitis-B vaccine dose by at least a few months, a move that could needlessly expose thousands of newborns to the virus, but was temporarily blocked by a federal judge on the ground that the illegally constituted ACIP had recommended the change. Without consulting C.D.C. scientists, Kennedy announced, on X, that healthy children and pregnant women no longer need the COVID vaccine—but, even before the announcement, less than fifteen per cent of children and pregnant women were getting the shot. “I’m actually somewhat surprised that he hasn’t totally gotten rid of COVID vaccines,” David Gorski, a surgeon at Wayne State University who manages the blog Science-Based Medicine, told me. “I think he’s probably just discovering that the bureaucracy is more difficult to move than he thought.”
Kennedy has arguably been constrained, not unleashed, under Trump. “Even a lot of Republicans don’t want to go where Kennedy wants to go,” Dorit Reiss, a vaccine-policy scholar at U.C. Law San Francisco, told me. White House advisers have argued that his vision would be politically injurious ahead of the midterms. Around the time that a prominent Republican pollster circulated a memo saying that “vaccine skepticism is bad politics,” one official said that the Administration was “done” with the issue. G.O.P. lawmakers also know that most of their constituents want to maintain access to vaccines. And so, for the most part, the Administration has not withdrawn its support for specific vaccines, a move that could spur insurance companies and public vaccination programs to stop covering them. Instead, it has issued far more muted advice, such as “shared clinical decision-making” between doctors and patients. After Kennedy swapped in his own people on the C.D.C.’s vaccine-advisory committee, Fiona Havers, an infectious-disease specialist and a former C.D.C. official, had a “huge fear” that children would lose access to immunizations, she told me. “But I think the Administration quickly realized that denying insurance coverage for vaccines was not a headline that played well.”
Even the recent effort to replace the combined M.M.R. vaccine with separate shots for measles, mumps, and rubella may have little effect. Such a change would likely lower vaccine uptake by making it more difficult for children to get all the vaccinations they need. But, in practice, separate shots for measles, mumps, and rubella aren’t even available in the U.S. Manufacturers estimate that it could take them a decade to bring them to market. Reiss told me that she is deeply concerned about the damage Kennedy has done: “He’s smashed norms of good governance—he’s done things by fiat in a non-deliberative, non-transparent way.” At the same time, she said, “He hasn’t wrecked our vaccine infrastructure in ways that can’t be fixed if a science-based Administration comes into power.” If the culmination of Kennedy’s crusade against vaccines is a set of narrow, legally contested, and reversible recommendations—recommendations plainly rejected by most medical professionals—then it is hard to argue that his war of maneuver has gained that much ground.
Of course, Trump and Kennedy are engaged in a war of position, too: they are working to change minds as well as policy. Trump won the election in 2024 by a greater margin than he had in 2016, and Kennedy has made meaningful strides toward normalizing his vaccine-skeptical views. Children’s Health Defense, an advocacy group that Kennedy helped bring to prominence, has become a leading purveyor of pseudoscience; a 2019 study found that, along with one other group, the organization had purchased more anti-vaccine Facebook advertisements than any other. Kennedy himself ranks among the “Disinformation Dozen,” as the Center for Countering Digital Hate labelled the twelve individuals who spread a large proportion of misleading medical information during the pandemic. Worryingly, the share of Americans who say that it’s very or extremely important that parents get their children vaccinated has fallen sharply in recent decades. Kennedy’s Make America Healthy Again movement, which got its name just two years ago, now counts more than forty per cent of the country as supporters.
There’s reason to think that even these gains are less dramatic than they appear, though. Support for MAHA depends heavily on MAGA, the Trumpian movement after which it was named. And the most important issue to MAHA voters is not the abolition of vaccines but the affordability of health care. According to the health-news site KFF, only a tenth of the movement’s supporters cite vaccines as their top priority, and nearly eighty per cent of parents in the movement believe that the M.M.R. shot is safe. After South Carolina experienced a major measles outbreak last year, vaccination surged; in one hard-hit area, nearly twice as many M.M.R. doses were administered in early 2026 than had been in the same period of the previous year. Today, the vast majority of Americans still say that they trust doctors and scientists for information about their health. Faith in Kennedy started low and has fallen further. Just after he took office, almost half of Americans disapproved of him; in an April poll, sixty per cent of voters did.
“Things could be worse” is no cause for celebration. Rather, it should be a call to action. Gramsci argued that the period between an old order and a new one was a “time of monsters,” when extreme movements and dangerous leaders reared their heads. Confronting them required a “pessimism of the intellect”—a readiness to take the peril seriously—in addition to an “optimism of the will.” The battle for sound vaccine policy and effective public health is worth fighting, and it is winnable. Earlier this year, the American Academy of Pediatrics and other groups prevailed in a lawsuit against Kennedy’s reconstitution of the C.D.C.’s vaccine-advisory committee, stalling its overhaul of the childhood-vaccine schedule (the government has appealed). State governments have banded together to develop their own vaccine guidance, rejecting the recommendations of an increasingly unreliable federal government. The nation’s largest association of health insurers has committed to continue covering, at no cost to patients, all ACIP-recommended immunizations, at least through the end of next year. It can be easy to feel hopeless in the face of a senseless assault on science. But it is not too late to shore up the fortresses and earthworks. Many still appear to be holding—for now. ♦
