Could Trump, RFK Jr. affect vaccinations in NY? Public health experts weigh in.

Some New York doctors and public health experts are bracing themselves for how President-elect Donald Trump could influence policies and attitudes around vaccines, although there are guardrails in place against wholesale changes.

Trump has promised to give Robert F. Kennedy a prominent role in the White House, raising questions about the vaccine skeptic’s potential to sway federal policy and messaging around immunization.

Public health experts say there are plenty of ways a federal government hostile to vaccines could threaten immunization efforts, even in New York, where city and state officials are committed to promoting the public health measure. That includes through appointments to federal agencies, federal funding for vaccine programs, and official guidance and messaging around vaccines.

Some New Yorkers in health care say they’re ready to double down on their endeavors to reassure patients about vaccine safety and efficacy, using lessons learned from the COVID-19 pandemic.

“We are already pushing a boulder up the hill when it comes to confidence in vaccination and combating vaccine hesitancy,” said Dr. Chelsea Faso, a physician with the Institute of Family Health. The institute runs clinics across New York City and the Hudson Valley. “This will just steepen the hill or push the boulder back down the hill. So I do worry about it.”

But the federal government is also limited in what it can do, and some health care providers say they are confident that New York will be able to protect access to vaccines. It’s up to each state to decide whether to require vaccination in public schools (all 50 states do) and whether to allow for religious exemptions (New York does not). States have had the power to set their own policies on COVID-19 vaccine mandates.

“The FDA obviously affects what gets approved, but once things are approved, it’s a states’ rights issue,” Dr. Mitchell Katz, president and CEO of NYC Health and Hospitals, said at a press conference the day after the election. Katz was responding to a question about Trump’s potential to affect vaccine access in New York.

Trump’s messaging on vaccines has been mixed, making it hard to tell exactly what he will do in office. He has taken credit for the rapid development of the first COVID-19 vaccines, which he helped accelerate through Operation Warp Speed during his first term. But that accomplishment wasn’t a central focus of his presidential campaign.

At campaign rallies, Trump repeatedly said he would pull federal funding from schools that mandate vaccines, although a spokesperson for his campaign told New York magazine earlier this year that he specifically meant COVID shots. This month, he said he is open to talking with Kennedy and others about whether certain vaccines should be banned.

When asked about Trump’s support for vaccines, Karoline Leavitt, a spokesperson for his transition team, said "the American people re-elected President Trump by resounding margins because they trust his judgment and support his policies, including his promise to Make America Healthy Again alongside well-respected leaders like RFK Jr.”

Kennedy is reportedly on a short list to head the U.S. Department of Health and Human Services, which encompasses such agencies as the Centers for Disease Control and Prevention and the Food and Drug Administration. But even if he doesn’t get that appointment, he could have an influential role in public health during Trump’s presidency.

“I’m going to let him go wild on health, I’m going to let him go wild on the food, I’m going to let him go wild on medicine,” Trump said during one campaign rally.

Kennedy, for his part, recently told NPR that “we're not going to take vaccines away from anybody” — but added that he believes the science on vaccine safety “has huge deficits” he hopes to correct. Kennedy has spread misinformation about the potential harms of vaccines both individually and through the nonprofit he founded, the Children’s Health Defense.

How could the federal government exercise its power?

It’s unlikely that the president or his appointees would be able to influence the FDA to roll back existing approvals for vaccines without triggering a deluge of lawsuits, said Jason Schwartz, a professor of health policy at the Yale School of Public Health.

“That would be a very difficult legal hill to climb,” Schwartz said.

But he added that there are other levers the administration could pull. The CDC, for instance, is responsible for setting the childhood vaccination schedule that’s followed across the country and issuing guidance on vaccination that is picked up by state and local health departments.

“These recommendations, were they to be altered or dialed back or modified in the ways that we've been hearing from RFK Jr. and others associated with the campaign, could really dramatically recast the government’s long-standing stewardship of vaccination,” Schwartz said.

Federal requirements around which vaccines must be covered by insurers are tied to CDC recommendations, so changes in CDC guidance could also put patients’ coverage and access at risk, Schwartz added.

Many children in New York also get vaccinated through the federally funded Vaccines for Children program, which procures doses at a discount and sends them to health care providers across the country.

Regardless of what concrete policy changes are made, the federal government plays a major role in influencing people’s attitudes about vaccines, said Dr. Scott Ratzan, a professor at the CUNY Graduate School of Public Health and Health Policy.

“The anti-vax group is not going away,” he said. “They feel more empowered.”

Ratzan serves as executive director of Convince USA, a CUNY project that coordinates research and communication strategies around vaccine literacy. He said it is already challenging to push back against anti-vaccine messages that are circulated on social media and promoted by people with large followings like Kennedy. But he said efforts to promote vaccine literacy and uptake can be effective when they come from trusted messengers in schools, pharmacies, doctor’s offices and community organizations.

During the COVID pandemic, when New Yorkers from a range of backgrounds questioned the safety of the new vaccines, local groups were tapped to help improve vaccination rates in specific neighborhoods by tailoring messages to their respective communities.

Dr. Tarika James, chief medical officer for Bronx Community Health Network, said there’s still broader hesitancy about vaccines among some patients, and social media plays a big role in influencing them.

But she said addressing that hesitancy often comes down to education.

“Just giving the basic science behind why vaccines work and how they work will allay some of those fears,” James said.