Mainstreaming Mistrust: The Shift in US Vaccine Policy Under the Trump Administration

The triumph of these vaccines transformed public fear into collective relief, marking one of the greatest achievements in modern medicine. Given the historic role of vaccines in safeguarding humanity from devastating infectious diseases, the world is watching with concern as the United States undergoes a significant reversal in its vaccine policies driven by the current administration. This shift carries potentially far-reaching consequences that threaten to undermine both US and global immunization efforts. Although anti-vaccine activism has historically remained on the margins of public discourse, this landscape is shifting as Robert F. Kennedy, Jr (RFK Jr) has assumed leadership of the Department of Health and Human Services (HHS).Controlling infectious diseases has always required a collective approach because infections extend beyond the individual and carry the potential for widespread transmission. The world united to combat polio, rallying around the proven and effective solution of vaccination through a coordinated global effort. Several governmental and non-governmental organizations worked toward universal immunization. Since its launch in 1988, the Global Polio Eradication Initiative (GPEI) has made remarkable progress, reducing the number of children paralyzed by polio by 99 reducing global mortality by 79% in the first year of vaccination. 4 However, the pandemic also led to a 55 nearly 40% increase in the number of zero-dose children (not receiving even a single vaccine), rising from 56 13.3 million in 2019 to 18.2 million in 2021. 5 These developments underscore both the progress and 57 setbacks of recent years, emphasizing the need for IA 2030 to strengthen global immunization efforts. 58The overarching strategic priority of IA 2030 is to ensure that immunization programs are an integral part 59 of primary health care to achieve universal coverage. The COVID-19 pandemic highlighted the importance 60 of primary health care and revealed both strengths and vulnerabilities in health systems worldwide. 61Studies from low-and middle-income countries across all six WHO regions have documented the 62 profound impact of the pandemic on countries' health system functioning. 6 Common challenges include 63 gaps in governance and leadership, imbalances in human resources, mistrust between communities and 64 healthcare providers, persistent geographic and socioeconomic inequities, and insufficient health 65 financing to support system resilience. As the vaccine landscape and public expectations continue to 66 evolve, healthcare providers require additional support. For decades, ACIP and CDC have served as vital 67 and credible sources of guidance for institutions and agencies involved in public health globally. 68In the US, political interference in vaccine policy and shifts in scientific leadership have raised concerns 69 among the medical and public health communities, threatening evidence-based decisions and global 70 cooperation when strong leadership is essential. 7,8 Undermining the authority and expertise of national 71 public health institutions not only fails to foster informed public discourse but also increases the risk of 72 amplifying anti-vaccine activism and facilitating the spread of misinformation. 8 73 Vaccine hesitancy, which has existed since the earliest days of vaccination, continues to evolve according 74 to context, geography, and vaccine type. The WHO identifies vaccine hesitancy as a major threat to global 75 health. Vaccine hesitancy, defined as delayed acceptance or refusal of vaccines despite their availability 9 , 76 is influenced by factors such as complacency, convenience, and confidence. Although extensive safety and 77 efficacy data are available in peer-reviewed literature and reports from international health authorities 78 and independent professional groups, the central challenge often lies in the willingness to accept scientific 79 evidence. Confidence depends on trust in vaccine safety and effectiveness, in the health system that 80 delivers vaccines, and in the motivations of policymakers who recommend them. 9 81The global of these policy shifts are not yet known, but they are likely to 82 public trust by fueling vaccine potentially decreasing vaccine coverage, and weakening 83 international health collaborations-ultimately putting populations worldwide at risk. In the face of these 84 challenges, the response of health professionals and the scientific community will be critical. One example 85 is the independent analysis of the recent ACIP meeting, published in Vaccine in November 2025. 10 We 86 believe it is essential not only to address public concerns and counter misinformation, but also to protect 87 the integrity of key public health institutions and preserve the trust that is fundamental to successful 88 immunization programs. 89Not applicable. 91Author declares that he has no conflicts of 93 Disclaimers 94The authors' opinions are not those of any affiliated institutions or organizations. 95 96