Toolkit: Protecting Access to Vaccines

Published: 9/15/2025

Over the past 50 years, vaccines have saved an estimated 154 million lives worldwide—equivalent to nearly six lives every minute. Recognizing this extraordinary achievement, ACP continues to emphasize the vital role of immunizations in both health care and public health policy, particularly in the face of rising vaccine skepticism and spread of anti-vaccine misinformation. ACP remains steadfast in its commitment to advancing evidence-based immunization practices, equipping physicians to educate patients, and promoting policies that ensure equitable access to vaccines for all communities. 

ACTION:

ACP members can access members-only actionable materials.

Background 

The Centers for Disease Control and Prevention (CDC) has long recognized vaccines as one of the greatest public health achievements in the fight against common communicable disease. It is estimated that childhood vaccination prevents nearly 4 million deaths around the world each year. Public health agencies continue to confront evolving challenges in sustaining the benefits of vaccination. Global efforts led by organizations such as the World Health Organization (WHO) and UNICEF; emphasize vaccine equity, striving to reach populations with limited health infrastructure. Meanwhile, in the United States, the CDC and local health departments play a central role in monitoring vaccine safety, countering misinformation, and coordinating responses to outbreaks. The COVID-19 pandemic highlighted both the immense capabilities of public health agencies in rapidly deploying new vaccines when appropriately resourced and the ongoing difficulties of building public trust. Rising vaccine skepticism has driven a decline in overall vaccination rates, with kindergarten vaccine rates declining over the past five years to less than 93% nationally and far lower rates in some communities. This decline has allowed the reemergence of measles, previously declared eradicated in the U.S. in 2000, as communities drop below the 95% vaccination levels required for herd immunity. In 2025, a total of 1,375 measles cases were confirmed across 42 states. These experiences underscore that vaccination is not only a scientific achievement but also a public health responsibility that requires strong systems, sustained investment, and community engagement.

Additionally, the CDC Advisory Committee on Immunization Practices (ACIP) is responsible for reviewing scientific data and making the recommendations that the CDC uses to set adult and child vaccine schedules in the United States.  ACIP’s recommendations are closely tied to insurance coverage for immunizations, including for Medicare Part D, both traditional Medicaid and Medicaid expansion, the Children’s Health Insurance Plan (CHIP), and the federal Vaccines for Children Program, which provides free-of-charge vaccines to about half of U.S. children. 

Federal Activity 

Since the start of 2025, the Trump administration has taken several key actions related to U.S. immunization practices and regulatory processes, including:

  • In February 2025, Secretary of the Department of Health and Human Services (HHS) Robert F. Kennedy Jr. terminated a CDC vaccination awareness campaign for influenza in favor of a more “informed consent” approach, highlighting the risks and benefits of vaccination. Many argued that while informed consent is always important, highlighting the risks of obtaining a vaccine may obscure the protective benefits, and reduce the rate of vaccine uptake across the country.
  • Secretary Kennedy ordered unilateral changes to vaccine recommendations outside of the established process, including federal guidance for the COVID-19 vaccine.
  • Secretary Kennedy postponed the first ACIP annual meeting to an indefinite date (later held in June) and abruptly replaced all 17 existing ACIP members with individuals more closely aligned with his views.
  • In August, Secretary Kennedy requested that the Annals of Internal Medicine retract a peer-reviewed study documenting the safety of vaccines. The journal rejected that request noting that, “retraction is warranted only when serious errors invalidate findings or there is documented scientific misconduct, neither of which occurred here.”
  • In late August, the Trump administration fired the Director of the CDC after she reportedly refused to pre-approve changes to the vaccine schedule before a full scientific review could occur.  Following her ousting, other senior CDC officials with responsibility for immunizations and infectious disease prevention resigned, citing political interference in the scientific process. 

ACP joined other medical societies to warn that this turmoil at the CDC puts lives at risk, and to call on Congress to provide necessary leadership and oversight to protect the public health.

Public health funding and research has also been affected by actions taken by the new administration. For example: 

  • In March, the National Institutes of Health (NIH) terminated at least 33 research grants dedicated to studying vaccine hesitancy and strategies to increase uptake. ACP and three other professional medical societies issued a joint statement opposing the action, asserting that “[t]he abrupt termination of these grants undermines efforts to combat misinformation and build public trust—work that is especially paramount right now as our country faces an active measles outbreak.”
  • Later in March, Secretary Kennedy rescinded approximately $11 billion in COVID grants awarded to state and community health departments for testing, immunization, health equity, and other COVID-19 related initiatives.
  • In a further blow to public health and pandemic preparedness, Secretary Kennedy rescinded $500 million in federal funding for mRNA vaccine research, dealing a significant blow to scientific innovation that was extremely successful against COVID and shows great promise against respiratory viruses and some cancers.
  • An August executive order by the Trump administration directed the NIH, National Science Foundation, and other agencies to designate political appointees to oversee the federal grants process to ensure that research funding aligns with the administration’s political positions. 

ACP Action

In June, ACP led a resolution at the AMA House of Delegates condemning the changes that Secretary Kennedy made to ACIP and called for a Congressional investigation into his role in undermining the committee’s work. Specifically, Kennedy postponed the first ACIP annual meeting to an indefinite date and abruptly replaced all 17 existing ACIP members with individuals more closely aligned with his views.

The College also issued a statement in response to Secretary Kennedy’s actions, warning that these changes “will seriously erode public confidence in our government’s ability to ensure the health of the American public and it will endanger the safety, welfare and lives of our patients.”

As assaults on public health and immunization research continue to happen, ACP persists in calling out these harmful actions and advocating for sound policies that fortify the public’s health. In July 2025, ACP joined other professional medical societies and public health organizations to file a lawsuit against Secretary Kennedy for unlawfully making changes to vaccine policy and repeated disregard for federal procedural rules. The suit was filed in the U.S. District Court for the District of Massachusetts and assigned to Judge William Young, who also presided over other cases such as American Public Health Association et al. v. National Institutes of Health et al. and Massachusetts v. Kennedy. 

In response to the firing of the CDC Director, ACP led a statement with six other medical societies that expressed concerns for the impact on patient health and discussed the importance of the CDC and other federal public health agencies to make decisions based on the best-available scientific evidence, guided by qualified experts.

Following Secretary Kennedy’s testimony before the Senate Finance Committee, ACP issued a statement that his disregard for decades of evidence-based, proven science puts lives at risk, and that he should be removed from his role as HHS Secretary. 

State Activity

Since 2021, state legislatures have introduced more than 2,500 vaccine-related bills, including nearly 500 in 2025 alone. These bills have addressed topics including vaccine requirements, vaccine access, who is permitted to administer vaccines, insurance coverage for immunizations, and vaccine registries and reporting. Although none have yet been enacted, at least 15 bills in 2025 proposed banning mRNA COVID-19 vaccines or mRNA vaccines more generally.

Every state has laws requiring that children must receive certain vaccinations to attend public schools. These requirements function as the primary vehicle through which the United States vaccinates its population and has historically aligned state vaccine requirements with recommendations from ACIP. Florida’s Surgeon General announced in September plans to try to become the first state to eliminate all state immunization requirements, which ACP strongly opposes.

As the disruption to ACIP has undermined confidence in their recommendations, states have started to amend their laws to allow state officials to consider recommendations from other groups. In 2025, Colorado passed a law directing the state Board of Health to seek vaccine recommendations from other sources in addition to ACIP including ACP, the American Academy of Pediatrics, the American Academy of Family Physicians, and the American College of Obstetricians and Gynecologists. California, Oregon, Washington, and Hawaii announced in September a West Coast Health Alliance to coordinate on their own evidence-based vaccine recommendations “in response to recent federal actions that have undermined the independence of the CDC and raised concerns about the politicization of science.” A growing number of states have also issued orders to allow pharmacists to vaccinate for COVID-19 despite federal restrictions limiting booster shots to individuals aged 65 and over. ACP anticipates that many states will consider similar legislation during the 2026 legislative session.

Every state allows exemptions for children from school vaccination requirements who cannot receive vaccinations for medical reasons. ACP believes that allowing exemptions from vaccinations based on non-medical reasons poses a risk to the public’s health and therefore opposes non-medical exemptions from vaccines. Most states, however, do accept alternative exemptions primarily for religious and/or philosophical beliefs, and only five states accept solely medical reasons to exempt individuals from vaccines. Among those that accept alternate exemptions, forty-three states allow exemptions for religious purposes and sixteen states allow exemptions for personal and/or philosophical beliefs. 

At least thirteen states have enacted statewide vaccine purchasing programs where states assess payers, buy vaccines in bulk, and then provide vaccines to physicians and health care organizations at no cost. These programs aim to increase access to vaccines by reducing overhead costs and administrative burden from maintaining a vaccination program in a practice. In 2025, Hawaii became the thirteenth state to enact a universal purchasing program, which will cover vaccine costs for all individuals age 64 and younger.

References