美国总统特朗普于本周一签署一份行政令，计划全面调整联邦政府儿童疫苗接种指导方案。尽管几乎没有科学依据支撑这类大幅调整，特朗普仍主张拉长婴幼儿疫苗接种周期、减少单次接种疫苗种类。
这份覆盖面极广的行政令提出，减少低龄儿童常规推荐接种疫苗总数量，并将全美儿童疫苗接种方案划分为三类。文件还要求将麻腮风三联疫苗(MMR)拆分为麻疹、腮腺炎、风疹三种单独疫苗接种。这一颠覆性改动违背主流医学界共识，但契合特朗普近几个月反复提出的修改该联合疫苗的主张。
白宫政府表示，将推动各州修订本地疫苗强制接种规定，落实联邦这套新指导标准，这会彻底颠覆长期以来旨在提升儿童疫苗覆盖率的现行制度。
特朗普在椭圆办公室表态：“我们要减少疫苗接种。不只是减少注射针剂数量，还会分多次就诊完成接种。”
卫生与公众服务部部长小罗伯特・F・肯尼迪等一众高级卫生官员陪同特朗普出席签字仪式。现场特朗普发表多处误导、不实的疫苗相关言论，甚至声称麻腮风疫苗 “存在致命风险”。
他多次毫无依据地宣称，如今儿童接种的疫苗总量超出身体承受能力，应当拉长各针次间隔。当被追问为何要分五次就诊给婴幼儿接种疫苗时，特朗普称自己当年就是这样安排自家孩子接种，“全程没有出现任何问题”。
医疗专家长期警告，这类调整会降低整体免疫覆盖率，让儿童更容易感染传染病。但特朗普对此坚称：“我们的调整不会带来任何不良后果，绝对不会。”
共和党参议员比尔・卡西迪本身是医生，去年就因肯尼迪的疫苗、自闭症相关观点，对提名其出任卫生部长一事持保留态度。此次行政令一出，他立刻公开批评。
卡西迪在社交平台 X 发文：“这份行政令完全错误。总统不具备做出此类调整的专业知识。疫苗整体安全性极高、防护效果明确，疫苗不会引发自闭症。拆分联合疫苗意味着孩子要打更多针才能获得同等防护，非但不能减少针次，还会加剧民众疫苗犹豫，让儿童健康风险上升。”
依据这份行政令，联邦新政策规定，所有儿童仍建议接种麻疹、腮腺炎、风疹、白喉、破伤风、百日咳、脊髓灰质炎、b 型流感嗜血杆菌、肺炎球菌、人乳头瘤病毒、水痘疫苗。
而呼吸道合胞病毒(RSV)单克隆预防制剂、甲肝、乙肝、B 型脑膜炎球菌、ACWY 群脑膜炎球菌、登革热疫苗，仅建议高危人群接种。现行方案原本推荐全体儿童接种以上大部分疫苗，此次调整改动巨大。
甲肝、乙肝这类疫苗，今后将采用医患共同决策模式，由家长和医护人员沟通后自主选择;轮状病毒、脑膜炎球菌、流感、新冠疫苗也归入此类。
联邦新版指导意见提出，将疫苗分散至多次就诊完成，“方便家长自主选择接种时间与频次”。但特朗普在椭圆办公室的表述直白得多：他认定现行集中接种方案不安全。
特朗普称：“简单来说，现在孩子一次性要注射大量疫苗，体量堪比一瓶汽水。我们每次只打总量的两成，拉长就诊间隔，让身体有时间代谢这些药剂。”
目前没有任何科学证据能佐证特朗普的这套说法。
本次新政延续了卫生与公众服务部今年 1 月缩减儿童推荐疫苗清单的举措。当时多家医学团体提起诉讼，法院最终裁定政府修改方案无效。法官在判决书中写道，肯尼迪去年组建的疫苗独立顾问专家组，专业能力存在 “明显短板”。
白宫顾问海蒂・奥弗顿周一谈及此前败诉一事时表示，政府会直接对接各州推进新规，不再寄希望于司法程序，尽快推动各州修改法规，让家长尽早享受新政。
特朗普发布疫苗新政前不久，参议院共和党人公开了前顶级公共卫生专家安东尼・福奇公务手机里 2021 年的短信记录，内容是福奇讨论新冠疫苗对孕妇存在潜在风险。但后续大量医学研究证实，孕妇接种新冠疫苗安全可靠。
有记者询问，共和党参议员要求司法部以藐视国会罪名起诉福奇一事进展如何。特朗普回应，他尚未与华盛顿联邦检察官吉妮恩・皮罗商议此事。
近几个月，特朗普持续施压肯尼迪，要求其大幅修改儿童疫苗接种方案，二人都公开揣测疫苗与自闭症存在关联。但全球大量权威医学研究均证实，二者不存在任何因果关系。
特朗普的疫苗新政也遭到白宫政治顾问的长期反对。顾问们认为，这类极具争议的疫苗政策不得民心，会在 11 月中期选举前流失选民。
今年早些时候，白宫官员曾劝说肯尼迪将工作重心转向更受大众认可的公共卫生项目，担心疫苗议题引发负面政治冲击，但卫生部仍在私下推进疫苗政策调整。
特朗普表示：“这件事对所有人都至关重要，我十分高兴签署这份行政令。”
周一当天，业内对拆分麻腮风疫苗的实操可行性充满质疑 —— 目前美国市场并无单独售卖的麻疹、腮腺炎、风疹单价疫苗。
一名白宫官员透露，卫生与公众服务部正与药企合作，推动单独疫苗上市，肯尼迪需在 90 天内出台拆分疫苗落地方案。 该官员称：“总统长期主张拆分麻腮风三联疫苗，希望家长能有单独接种的选择。”
另一名白宫官员辩解：“这份疫苗政策并非总统主观随意制定。” 该官员提及卫生部今年 1 月出具的一份科学评估报告，正是这份报告支撑了此前被法院叫停的疫苗修订方案。 但这份评估报告并未论证拆分麻腮风疫苗的安全性、有效性与实际价值。
儿科医生与各大医学组织普遍忧心，部分疫苗不再面向全体儿童推荐后，想给孩子完整接种全套疫苗的家长可能需要自行承担高额费用。
美国法律规定，保险公司必须全额报销疾控中心免疫实践咨询委员会(ACIP)推荐的全部疫苗，无需民众自付费用。该专家委员会去年已被肯尼迪更换全部成员。
新一届委员会部分成员本身持反疫苗观点，此前已提议将乙肝疫苗接种时间从婴儿期推迟至 12 岁。而特朗普周一签署的行政令，直接把乙肝疫苗调整为仅高危人群推荐接种。
白宫官员对此解释：“新政仅调整推荐范围，理论上这类疫苗依旧纳入保险报销，有需求的家长仍可免费接种。”
Trump signs executive order aimed at reducing number of recommended childhood vaccines
President Donald Trump signed an executive order on Monday aimed at reshaping the federal government’s approach toward childhood vaccines, insisting that infants should receive fewer immunizations over a longer period despite little scientific evidence supporting such sweeping changes.
The wide-ranging order proposes reducing the total number of immunizations recommended for children in their earliest years and dividing the nation’s childhood vaccine schedule into three categories.
It also advises that the mumps, measles and rubella (MMR) vaccine be separated into three individual shots — a dramatic change that goes against broad scientific consensus but is in keeping with Trump’s insistence in recent months that the widely administered shot be altered.
The administration signaled that it will push states to rework their vaccine requirements to incorporate the new federal guidelines, effectively upending longstanding practices aimed at improving childhood immunization rates.
“We’re reducing them,” Trump said from the Oval Office. “It’s not only that you’re doing fewer vaccines, or jabs, as they say, but you’re doing them in a series of visits to the doctor.”
Flanked by an array of top health officials, including US Health and Human Services Secretary Robert F. Kennedy Jr., Trump made a range of misleading and incorrect claims about vaccines, including suggesting at one point that the MMR shot can be “quite lethal.”
He alleged repeatedly and without evidence that children were being injected with more vaccines than they could handle, arguing that the shots should be spaced further apart. Pressed on his reasoning for recommending that infants receive their shots over five separate doctor visits, Trump said he’d done it with his children and “had no problem.”
“Nothing bad can happen from what we’re doing,” he said of changes that health experts have long warned will reduce immunization rates and leave children more susceptible to disease. “Nothing bad can happen.”
GOP Sen. Bill Cassidy, a doctor who expressed hesitancy last year over confirming Kennedy to the HHS post due to his positions on vaccines and autism, immediately criticized the order.
“This executive order is wrong. The President does not have the expertise to make these changes. Vaccines are overwhelmingly safe. Vaccines are effective. Vaccines DO NOT cause autism,” Cassidywrote on X. “Breaking up vaccines will mean children have to get more shots to get the same protection, not fewer shots. It will increase hesitancy and make children less safe.”
Under the order, the administration’s new policy states that all children are recommended to receive vaccines for measles, mumps, rubella, diphtheria, tetanus, pertussis, polio, Hib, pneumococcal disease, HPV and varicella, or chicken pox.
Only high-risk populations are now advised to receive respiratory syncytial virus (RSV) monoclonal antibodies and vaccines against hepatitis A, hepatitis B, meningococcal B, meningococcal ACWY and dengue. That marks a change from the current schedule, which recommends that all children receive most of those shots.
Several of those, such as the hepatitis immunizations, would be based on what’s called shared decision-making, or conversations with a healthcare provider. Those also include shots for rotavirus, meningococcal disease, influenza and Covid-19.
The administration’s new guidance suggests that that the immunizations be given over several medical visits “to give parents more options regarding the timing and frequency” of administration. But Trump offered a far blunter explanation from the Oval Office: He didn’t believe that the current regimen was safe.
“Very simply: Large amounts of vaccine, large amounts of — like vats — of vaccine are currently pumped into your child’s body,” Trump said, at another point comparing the amount of vaccine given to children as “the size of a bottle of soda.”
“We’re doing 20% of that at each visit, and we’ll let time elapse between visits so the body can handle this massive amount of fluid being pumped in,” he said.
There is no evidence to support Trump’s claims.
Trump’s announcement hews closely to an HHS effort in January towhittle down the number of recommended vaccinesin the childhood schedule. Medical groupssued to challengethat revised schedule, and a judge ruled in their favor,writing in his opinionthat there are “glaring gaps” in expertise among the people Kennedy named to an independent advisory panel on vaccines last year.
Referencing that earlier effort, White House adviser Heidi Overton said Monday that administration officials “are going to be working directly with states so that we’re not reliant on the court case to resolve. We are doing it right away so that parents get the benefit from state laws changing.”
The vaccine announcement came shortly after Senate Republicans released 2021 text messages obtained from Dr. Anthony Fauci’s government phone showing the former top health official discussing possible risks of the Covid-19 vaccine to pregnant women. Later studies showed that the vaccines were safe during pregnancy.
Asked about a push by Republican senators for the Justice Department to charge Fauci with contempt of Congress, Trump said he’d yet to talk about it with US Attorney for the District of Columbia Jeanine Pirro.
The Monday order on vaccines followed months of escalating pressure that Trump had put on Kennedy for more action on the childhood vaccine schedule, as the two men both publicly speculate about links between vaccines and autism.
There have been extensive scientific studies of vaccines that have yielded no evidence of a connection to autism.
It also came despite long-running reservations among Trump’s political advisers that advancing controversial vaccine policies is widely unpopular and could alienate voters ahead of November’s midterms.
White House officials earlier this year urged Kennedy to shift his focus to other, more mainstream initiatives due to concerns about the political fallout, though his department’s work on vaccines has continued in the background.
“This is something very important for all of us,” Trump said. “Very happy to sign it.”
Yet questions swirled Monday about the mechanics of separating out the measles, mumps and rubella vaccines, particularly because those are not sold separately in the US market.
HHS is working with the private sector to make those commercially available, and Kennedy is expected to produce a plan for separate vaccines within 90 days, a White House official said Monday.
“The president has long held that the MMR vaccine should be separated and wants that available as an option,” the official said.
Another White House official said, “This isn’t just the president …arbitrarily setting vaccine policy.” The official pointed to a Januaryscientific assessmentthat HHS carried out before unveiling the proposed schedule that was eventually blocked in court.
That assessment does not specifically address the utility, safety or effectiveness of separating the measles, mumps and rubella shots.
Concerns spiked Monday among pediatricians and medical groups that removing broad recommendations for certain childhood vaccines could mean out-of-pocket costs for parents who do want to fully vaccinate their children.
By law, insurers must cover without cost to patients the vaccines that are recommended by the US Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices, the panel of experts who Kennedy replaced last year.
The new contingent on the panel, some of whom have stated objections to vaccines, has already discussed delaying hepatitis B vaccination from infancy to 12 years of age. The changes ordered by Trump on Monday would recommend hepatitis immunizations only for high-risk populations.
“They still are a recommendation, and so we assume that that means they’ll still be covered by insurance and fully available to parents that want them,” the first official said Monday.
