The need to increase access to pharmacy services is one of the profession’s cardinal principles. It should therefore be especially distressing for community pharmacists when the Secretary of Health and Human Services, Robert F. Kennedy Jr., and the agencies he oversees make decisions that result in the erosion of patients’ ability to receive immunizations in their stores.
Since becoming HHS secretary in February, Kennedy — a noted vaccine skeptic — has sown doubt about the safety and efficacy of immunizations. Now changes in federal policy are beginning to have a direct impact on what goes on in the pharmacy. While approving updated versions of COVID-19 vaccines late last month, the Food and Drug Administration recommended that their use be limited to people over age 65 and individuals with underlying health conditions. It didn’t take long for the move to trigger real-world consequences.
CVS Health and Walgreens, the nation’s two biggest pharmacy chains, reacted by limiting access to COVID immunizations in several states. CVS will only administer COVID shots to patients with a prescription in 13 states and the District of Columbia; the service is not available to anyone at its stores in Massachusetts, Nevada and New Mexico. For its part, Walgreens is implementing a similar policy, guided by the FDA decision and state regulations. The upshot is that patients will find that it is more difficult to be immunized against COVID than at any time since the vaccines were first made available at community pharmacies in early 2021.
The move by the FDA is just one aspect of the assault on the public health infrastructure. In June, Kennedy dismissed all 17 members of the Advisory Committee on Immunization Practices (ACIP), a panel of scientific and medical experts, and replaced them with individuals less qualified to evaluate the safety and efficacy of vaccines. He subsequently ended funding for further development of mRNA, the molecule underlying the two most widely used COVID vaccines, produced by Pfizer and Moderna.
In addition, Kennedy recently upended the leadership of the Centers for Disease Control and Prevention by persuading President Trump to fire Susan Monarez, a microbiologist who served as CDC director for just 29 days. Her dismissal prompted three other top CDC officials to resign.
In a Wall Street Journal op-ed, Monarez wrote about a meeting with Kennedy, who asked her to preapprove ACIP recommendations. When she refused, she was terminated.
“Those seeking to undermine vaccines use a familiar playbook: Discredit research, weaken advisory committees and use the manipulated outcomes to unravel protections that generations of families have relied on to keep deadly diseases at bay,” Monarez said. “If we stay silent, preventable diseases will return — as we saw with the largest measles outbreak in more than 30 years, which tragically killed two children.”
Kennedy subsequently denied making such a demand at a contentious Senate Finance Committee hearing, where both Republicans and Democrats expressed concerns about the turmoil at HHS and the adverse effect it will have on the health and well-being of Americans. Despite being short on specifics and data to back up his assertions, Kennedy stuck to his guns. He argued that the policies he is implementing will make Americans healthier and restore trust in the CDC and related federal agencies.
In regard to immunizations, it’s clear that Kennedy is wrong. The link between vaccines and autism to which he and his allies frequently allude has been debunked by more than 15 scientific studies, conducted over many years in many nations. Like other pharmaceuticals, vaccines do cause adverse events in a small number of cases, but those rare incidents are dwarfed by the hundreds of millions of people, particularly children, every year who benefit by being immunized.
The availability of vaccines has limited or eradicated a variety of serious illnesses, including polio, smallpox, malaria, tetanus, hepatitis-B and, as Monarez noted, measles. Community pharmacists have done much to contribute to that success. During the COVID pandemic, they administered more than 350 million immunizations, enabling the country to get back to normal. And pharmacies are the place that most people now turn to get a flu shot.
Pharmacists know as well as anyone what’s at risk — a stable vaccine system that plays a leading role in keeping Americans healthy. Encouraged by the signals from Kennedy and other federal officials, Florida has indicated that it intends to end all immunization mandates for children, while California, Oregon and Washington state, believing that they can no longer rely on HHS, plan to form a consortium to advise residents about immunizations. A patchwork of state regulations would undo the work of decades and needlessly put patients in danger. Members of the pharmacy profession need to unite and make their voices heard, reinforcing the resistance to the assault on public health.
