This week’s announcement by Health Secretary Robert F. Kennedy Jr. that the CDC will represents more than just a policy shift — it constitutes a fundamental assault on evidence-based medicine that will have far-reaching consequences for patients, physicians, and public health. That includes every one of us, directly or indirectly, right or left or middle. This decision, , marks a serious departure from medical consensus that especially endangers the most vulnerable members of our society. Many, many of us are livid. I am so angry about what these radicals are doing to our country and health care that I found myself singing the national anthem, loudly, tearing up, off-key as usual, before the Phillies game on Tuesday night here in Philly.

When I sing the national anthem, despite being embarrassed about my horrible singing voice, you know we are in desperate times. And so in that patriotic spirit of defending my little turf as a primary care physician here in the birthplace of American liberty, let me swing for the fences on this post about what’s really going down with this anti-vaccination proclamation from a lawyer.

It is irrelevant to the following discussion that only 15% of children and pregnant women in the US received the latest Covid shots. That’s a separate fail with many causes. Secondly, it is irrelevant to the following discussion that some people believe randomized controlled trials are the only gold standard, and that we must throw out our silver and platinum. Would you throw out your wife’s silver and platinum jewelry? Yes? Good luck explaining that. But my friends Vinay, Jay, and Marty told me they were worthless…

In case you missed the video carnage, here it is. And here are two excellent articles from STAT News to catch you up on the implications 1, 2. Consider them primary resources for this post.

The scientific foundation supporting COVID-19 vaccination in is overwhelming and unambiguous despite what these guys say. Consider the comprehensive systematic review and meta-analysis involving over 17 million pregnant individuals which found no safety concerns for COVID-19 vaccination during pregnancy, with researchers concluding that findings "support authorized or approved COVID-19 vaccines for pregnant persons." This massive body of evidence, spanning multiple countries and healthcare systems, demonstrates consistent safety across all trimesters of pregnancy, with no increased risk for stillbirth, preterm birth, congenital malformations, or pre-eclampsia. I’ve written about plenty of other studies, too. I sincerely invite the surgeon, the doctor who never did residency or practiced actual medicine, and the lawyer to read them.

The American College of Obstetricians and Gynecologists (ACOG) maintains strong recommendations that "all eligible persons, including pregnant and lactating individuals, receive a COVID-19 vaccine or vaccine series," based on careful evaluation of risk-benefit ratios that recognize pregnancy as a significant risk factor for severe COVID-19 outcomes. Pregnant women face elevated risks including increased rates of severe illness, ICU admission, and maternal mortality, while provides crucial protection for

ACOG released this statement two days ago in response, because what else are you going to do when you’ve taken a freaking oath to your patients:

ACOG is concerned about and extremely disappointed by the announcement that HHS will no longer recommend COVID-19 vaccination during pregnancy. As ob-gyns who treat patients every day, we have seen firsthand how dangerous COVID-19 infection can be during pregnancy and for newborns who depend on maternal antibodies from the vaccine for protection. We also understand that despite the change in recommendations from HHS, It is very clear that COVID-19 infection during pregnancy can be catastrophic and lead to major disability, and it can cause devastating consequences for families. The COVID-19 vaccine is safe during pregnancy, and vaccination can protect our patients and their infants after birth.

“In fact, growing evidence shows just how much vaccination during pregnancy protects the infant after birth, with the vast majority of hospitalized infants less than six months of age—those who are not yet eligible for vaccination—born to unvaccinated mothers.

“Following this announcement, we are worried about our patients in the future, who may be less likely to choose vaccination during pregnancy despite the clear and definitive evidence demonstrating its benefit. We are concerned about access implications and what this recommendation will mean for insurance coverage of the COVID-19 vaccine for those who do choose to get vaccinated during pregnancy. And as ob-gyns, we are very concerned about the potential deterioration of vaccine confidence in the future.”

Yet Kennedy's decision dismisses this extensive evidence base without providing countervailing scientific data or transparent justification. The announcement, delivered through a brief social media video rather than established scientific channels, represents a dangerous precedent of

The policy reversal poses particularly grave risks for young children, who remain among the most vulnerable to COVID-19 complications. At least 1,800 children have died of COVID-19 in the United States alone, a sobering reminder that this disease is not benign in pediatric populations despite persistent misconceptions. It’s probably a higher number, but statistics are now difficult to find. This was the scenario through 2022 at least, even as many kids were vaccinated and had suffered previous infections:

Children can develop severe acute illness requiring hospitalization and intensive care, and mounting evidence shows they face not insignificant risks of long COVID, with symptoms including fatigue, cognitive difficulties, loss of IQ points, and decreased physical endurance that can persist for months or years after initial infection.

The policy change creates , who were previously protected through maternal vaccination during pregnancy. These babies, too young to be vaccinated themselves, relied entirely on antibodies transferred from vaccinated mothers for protection during their most vulnerable early months of life. By removing recommendations for maternal vaccination, the policy eliminates this critical shield for newborns, leaving them exposed to a disease that can cause severe respiratory illness, multisystem inflammatory syndrome, and other serious complications in infants.

This youngest age group now faces a particularly dangerous : they are simultaneously too young to receive direct vaccination protection, stripped of the maternal antibody protection that previous policy provided, and now deprived of routine vaccination after 6 months of age, too.

Recall that in the original studies in unvaccinated children, the mRNA vaccines were about 90% effective in preventing symptomatic disease. Recall that unvaccinated children are still being born every second. Observational studies over the last 4 years have consistently shown durable protection against severe disease, though decreasing efficacy against preventing infection. And yet studies still show that keeping kids up to date on Covid vaccines helps reduce illnesses, doctor visits, missed school, and long Covid in children.

Dr. Paul Offit, fellow Philadelphian and esteemed physician, had this to report in his Substack this morning:

On April 15, 2025, one month before RFK Jr.’s announcement, Fiona Havers from the CDC presented data to the Advisory Committee on Immunization Practices (ACIP), an independent group of experts that advises the CDC on vaccines. The committee learned that :

• About 165,000 people were hospitalized with Covid and 40,000 died.

• About 4.3 percent of Covid hospitalizations occurred in children.

• About 150 children died from Covid, most were less than 4 years old.

• About 50 percent of children less than 4 years old who were hospitalized or died from Covid were otherwise healthy.

• About 1 in 5 children hospitalized with Covid were admitted to the intensive care unit.

•

• More young children died from Covid than died from influenza.

• A disproportionate number of children who died from Covid were less than 6 months old. The only way these children could have been protected from Covid would have been if their mothers had been vaccinated during pregnancy, which would have allowed those babies to acquire protective antibodies through the placenta.

Leadership of the American Academy of Pediatrics came out strongly against this RFK Jr “policy” change. Good for them, too:

“By removing the recommendation, the decision could strip families of choice,” said Sean T. O’Leary, M.D., M.P.H., FAAP, chair of the AAP Committee on Infectious Diseases. “Those who want to vaccinate may no longer be able to, as the implications for insurance coverage and access remain unclear. … What is clear is that pregnant women, infants and young children are at higher risk of hospitalization from COVID, and the safety of the COVID vaccine has been widely demonstrated.”

And my tribe, the family physicians, also stepped up with this statement from Jen Brull, President, American Academy of Family Physicians:

“Vaccines are safe, effective and save lives. The COVID-19 vaccine has significantly reduced hospitalizations and deaths across all age groups. The recent announcement of intended changes to the recommended immunization schedule for children and pregnant persons circumvents the established process for vaccine review and recommendations and, if fully implemented, would be a dangerous setback. We protect public health by allowing trusted experts with backgrounds in science and medicine to review data and make recommendations for what vaccines should be included in the Vaccines for Children program and in recommendations for other groups – not by allowing non-clinicians to make unilateral decisions.

Vaccines play a crucial role in protecting vulnerable groups, especially children and pregnant patients and their caregivers, against disease. These changes would also undermine access, impact insurance coverage and impede progress made toward improving public health. We urge patients to talk with their family physician and make decisions based on trusted, evidence-based care.”

Many OB/GYNs, pediatricians, and family docs in particular are pissed. One such physician named Dr. Annie Andrews just launched a Senate bid in the state of South Carolina. Physician friends of friends have told us that she is “awesome.” If you need a little energy and hope, watch this campaign video she just dropped today. Though I live in Philly, I’m going to send her campaign money. She writes here on Substack, so you should subscribe to her newsletter called Don’t Tread on Kids. We follow each other on Bluesky, and I’m proud our country can still produce such brave, competent, intelligent, talented potential leaders and pediatricians:

Now back to the vaccine debacle.

Equally concerning is the complete . Normally, recommendations for vaccines are made by the CDC director based on votes by the Advisory Committee on Immunization Practices (ACIP), which meets in public with independent experts reviewing evidence transparently. This process, designed to keep public health officials honest and their decisions transparent, was entirely bypassed. Kennedy made a unilateral decision without ACIP consultation, public input, or peer review.

This represents a 180-degree turn from the historical development of peer review in American science, which emerged after World War II specifically . Historian Melinda Baldwin has noted that the current approach suggests that "the president's agenda is the most important consideration for any government spending," even when it contradicts established scientific evidence.

His statements that the NIH will "probably stop publishing in the Lancet, New England Journal of Medicine, JAMA, and those other journals because they're all corrupt" signal an attempt to control scientific discourse by . This represents a fundamental threat to scientific independence and peer review processes that have been essential to medical progress. It represents authoritarian, anti-American, anti-scientific malarkey that will absolutely harm research and health.

Let’s narrow the scope of this subtle disaster and show how this is going to affect you and me in the examining room and beyond.

Your doctor now faces an unprecedented ethical and professional crisis. The robust scientific evidence still supports COVID-19 vaccination for pregnant women and healthy children (especially the little ones not yet vaccinated), yet new federal policies restrict official recommendations to only older adults and high-risk groups. This forces physicians into an impossible position where they must choose between:

: Recommending vaccines based on the best available scientific data and established benefit-risk profiles, but doing so "off-label" and outside the protection of official federal guidelines.

: Adhering to new restrictive policies, thereby withholding a preventive measure that research shows reduces serious illness in groups previously recommended for vaccination.

When physicians recommend vaccines that federal agencies no longer officially endorse, they face that could directly impact your access to care:

: Doctors may lose liability protections under federal laws like the Public Readiness and Emergency Preparedness Act when making recommendations outside official guidelines. This exposure to lawsuits could make physicians even when they believe it's in your best interest. Lovely, right?

: State medical boards could potentially take disciplinary action against physicians who consistently recommend treatments outside federal guidelines, regardless of the underlying evidence supporting those recommendations. This is mostly a red state problem, as many are trying to criminalize mRNA vaccines. Like… they are a crime.

: Medical malpractice insurance may not cover claims related to treatments recommended outside official guidelines, creating financial risks that could influence clinical decision-making.

Guess who really wins in this sort of battle? Anti-vaccination forces, which despite their loud and hostile voices still make up a minority of the American population. I know of several doctor friends who are eyeing the exits, especially if the 2026 elections are actually stolen, or worse, if Americans actually double down on this regime and the Republicans who have given it carte blanche.

The policy reversal exposes to several categories of increased risk:

: If you're pregnant or have young children, you may face increased risk of severe COVID-19 illness without vaccination protection. Pregnant women have consistently shown higher rates of hospitalization, ICU admission, and complications from COVID-19 infection.

: As noted above, your doctor may feel pressured to withhold information about vaccination benefits or may be reluctant to engage in thorough discussions about all available preventive options. This undermines your ability to make fully informed healthcare decisions. And this is just the beginning of the war on vaccines. Next up HPV?

: The precedent set by overruling established vaccine recommendations without scientific justification could extend to other preventive measures, potentially affecting routine childhood vaccinations, maternal health interventions, and other evidence-based preventive care. Separation of church and state was a good idea for both parties. We should enshrine a separation of science and state, too.

As a patient, you need to understand that your healthcare provider is now operating in an environment where evidence-based recommendations may conflict with federal policy. Here's what this means for your care:

: Discussions about vaccination may become more nuanced and time-consuming as doctors navigate between scientific evidence and policy restrictions. Be prepared for longer consultations and more detailed risk-benefit discussions. Also be prepared for your exhausted, intimidated, kneecapped doctor to skip it entirely. You probably need to ask for vaccines. Please.

: You may receive different recommendations from different sources — federal agencies, professional medical organizations, and individual providers may offer varying guidance based on how they interpret the conflict between evidence and policy. This will undermine trust in vaccination across the board. That’s one of the sick goals.

: You may need to be more proactive in seeking information about all available options and explicitly asking your doctor about treatments that may not be officially recommended but are supported by evidence. More about this in future posts for sure. I’ll keep slinging my truth here, and citing the source like Doja Cat.

The consequences of this policy reversal extend far beyond COVID-19 vaccines. When political ideology supersedes scientific evidence in public health decision-making, it undermines the entire foundation of evidence-based medicine. Physicians depend on trusted, to provide consistent, high-quality care. When these guidelines become subject to , of medical institutions and creates chaos in clinical practice.

The coordinated targeting of prestigious medical journals as "corrupt" further threatens the peer review process that has been essential to medical progress. If government agencies create their own publication systems to bypass independent scientific review, it could fundamentally alter how medical knowledge is generated, validated, and disseminated.

Healthcare providers, professional medical organizations, and patients must work together to preserve evidence-based medical practice despite federal policy reversals. This means:

: Continuing to base recommendations on the best available scientific evidence while transparently discussing policy conflicts with patients. Professional medical organizations must maintain evidence-based guidelines and support physicians who follow them. We need ACOG, AAFP, AAP, ABIM and all the rest to step up, form a Voltron-like superstructure, and collectively honor our oaths.

: Seeking information from multiple sources, including professional medical organizations, and having frank discussions about all available options supported by evidence. Perhaps never has the idea of having a trusted family doctor meant so little and so much at the same time.

: Defending the integrity of peer review processes, supporting independent scientific research, and resisting attempts to politicize medical evidence. Subscribe to some top tier medical journals in your field if you have not for a while. Like local journalism, they could use some love and support.

And refocusing back on the news of the day, as blurted out by three guys during a one minute cringe video that will be remembered as The No Covid Shot Heard Round the World, don't abandon the extensive body of research supporting COVID-19 vaccination safety and efficacy. It has already provided a clear foundation for continued evidence-based practice, regardless of politically motivated policy changes. The protection of vulnerable populations and the preservation of scientific integrity in medical decision-making must remain paramount, even when federal agencies abandon these principles.

I thought about singing the national anthem for you. But you had to be in that moment as the Phillies took the field on Tuesday night.

Instead, I’m going to take mercy, and end this in the spirit of fellow Philadelphian Benjamin Franklin, with a writing style he used to pen Poor Richard’s Alamanack. This yearly publication combined practical information with witty proverbs and moral advice, and became one of colonial America's most popular and influential books.

When lawyers presume to practice medicine and politicians override physicians, the patient suffers most. 'Tis a curious thing that a nation which once valued the counsel of learned men now prefers the proclamations of those who never held a stethoscope.

We should proceed with fire in our bellies to protect babes and mothers from disease, whilst those in power dismiss mountains of evidence as easily as sweeping crumbs from the table. As Poor Richard would say: "He that falls in love with himself will have no rivals"—and so it seems with those who trust their own judgment over the accumulated wisdom of thousands of healers and hundreds of studies.

When ideology trumps investigation, and politics prevails over patients, we return to the dark days when bloodletting was preferred to vaccination.

A wise man learns from many masters,

but a fool makes himself teacher to all.