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One of the top vaccine experts at the US Centers for Disease Control and Prevention (CDC), , resigned on 4 June – a week after Robert F Kennedy Jr announced that covid-19 vaccines would no longer be recommended for most children and pregnancies.

The announcement set off several days of confusion around who will have access to covid-19 vaccines in the US going forward. In practice, there hasn’t been a drastic change to access, though there will probably be new obstacles for parents hoping to vaccinate their children. Still, Kennedy’s announcement signals a troubling circumvention of public health norms.

“My career in public health and vaccinology started with a deep-seated desire to help the most vulnerable members of our population, and that is not something I am able to continue doing in this role,” said Panagiotakopoulos in an email to colleagues obtained by .

Panagiotakopoulos supported the Advisory Committee on Immunization Practices (ACIP), which has advised the CDC on vaccine recommendations since . But last week, Kennedy – the country’s highest-ranking public health official – upended this decades-long precedent. “I couldn’t be more pleased to announce that, as of today, the covid vaccine for healthy children and healthy pregnant woman has been removed from the CDC recommended immunisation schedule,” he said in a posted to the social media platform X on 27 May.

Despite his directive, the CDC has, so far, only made minor changes to its guidance on covid-19 vaccines. Instead of recommending them for children outright, it now “based on shared clinical decision-making”. In other words, parents should talk with a doctor before deciding. It isn’t clear how this will affect access to these vaccines in every scenario, but it could make it more difficult for children to get a shot at pharmacies.

The CDC’s guidance on vaccination in pregnancy is also ambiguous. While its website still , a note at the top says, “this page will be updated to align with the updated immunization schedule.”

Kennedy’s announcement contradicts the stances of major public health organisations, too. Both the (ACOG) and the (APP) have come out opposing it.

“The CDC and HHS encourage individuals to talk with their healthcare provider about any personal medical decision,” an HHS spokesperson told ���ӽ紫ý. “Under the leadership of Secretary Kennedy, HHS is restoring the doctor-patient relationship.”

However, at the University of Washington in Seattle says the conflicting messages are confusing for people. “It opens up disinformation opportunities. It undermines confidence in vaccination in general,” she says. “I can’t imagine it won’t decrease immunisation rates overall.”

Research has repeatedly shown covid-19 vaccination in adolescence and pregnancy is safe and effective. In fact, Martin Makary, the head of the US Food and Drug Administration (FDA), listed pregnancy as a a week before Kennedy’s announcement, further convoluting the government’s public health messaging.

Kennedy’s announcement is in line with some other countries’ covid policies. For example, and the don’t recommend covid-19 vaccines for children unless they are at risk of severe illness. They also if someone is already vaccinated.

 at City St George’s, University of London says the UK’s decision was based on the reduced risk of the omicron variant, the cost-effectiveness of vaccination and high population immunity. She is part of two subcommittees of the UK Joint Committee on Vaccination and Immunisation, though neither was a part of the covid-19 vaccination decision.

However, these factors can vary across countries. The UK population also tends to have better access to healthcare than the US, says Eckert. “These decisions need to carefully consider the risks and benefits relative to the national population,” says Khalil. The HHS didn’t answer ���ӽ紫ý’s questions about whether a similar analysis guided Kennedy’s decision-making.

What is maybe most troubling, however, is the precedent Kennedy’s announcement sets. The ACIP – an independent group of public health experts – was expected to vote on proposed changes to covid-19 vaccine recommendations later this month. But Kennedy’s decision has bypassed this process.

“This style of decision-making – by individuals versus going through experts who are carefully vetted for conflicts of interest, who carefully look at the data – this has never happened in our country,” says Eckert. “We’re in uncharted territory.” She worries the move could pave the way for Kennedy to chip away at other vaccine recommendations. “I know there are a lot of vaccines he has been actively against in his career,” she says. Kennedy has previously blamed vaccines for autism and falsely claimed that the polio vaccine caused more deaths than it averted.

“What it speaks to is the fact that [Kennedy] does not see value in these vaccines and is going to do everything he can to try and devalue them in the minds of the public and make them harder to receive,” says Amesh Adalja at Johns Hopkins University.