Standing Up for Evidence-based Medicine
By John Gallagher
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A year ago, federal vaccination policy was the result of careful consideration from the Advisory Committee on Immunization Practices, a panel convened by the U.S. Centers for Disease Control and Prevention made up of experts recognized as leaders in their fields. Scientific rigor was the hallmark of their decision-making and U.S. vaccination policy was considered the global standard.
“The ACIP and the nationalization of vaccine policy led us to a place where we were considered world leaders,” says Helen Chu, MD, an immunologist and professor of epidemiology and medicine at the University of Washington and, until June 2025, an ACIP panelist. “It was policy decided on the basis of safety data, efficacy data, cost, and equity.”
Not anymore. Since Robert F. Kennedy Jr. assumed the role of the nation’s top health officer, the Secretary of Health and Human Services, he has discarded long-standing policies in favor of hurried decisions conforming to non-mainstream theories and based on long-discredited misinformation, especially the disproven link between vaccines and autism. He fired all 17 members of ACIP, including Dr. Chu, as well as the newly appointed CDC director, prompting the resignations of four top CDC officials, all physicians with decades of experience, who stepped down in protest of the firings.
Thanks to a new ACIP reconstituted with Sec. Kennedy’s handpicked choices, recommendations for routine childhood vaccines have shrunk from 17 to just 11, deviating from the American Academy of Pediatrics Recommended Child and Adolescent Immunization Schedule, which is based on vaccine safety and effectiveness evidence, and marking a dramatic break from the established procedure for vaccine policy recommendations. While the vaccines removed from the list will still be available, they will not be routinely administered. Instead, they are only recommended for high-risk children or after consultation with a doctor.
“We are no longer making decisions for the good of the people,” says Dr. Chu. “They are being made on complete falsehoods. In the past several months, we’ve seen a complete dissolution of the national progress that we’ve made.”
Those changes to federal immunization policy—based on junk science—jeopardize the health of patients. “When guidelines change without the data to support the change, it puts patients at risk,” says WSMA President Bridget Bush, MD. “We cannot say we are doing our best patient care when data doesn’t support our actions.”
Alan Melnick, MD, public health director for Clark County and a member of the WSMA board of trustees, is blunt. “The recommendations from the CDC are dangerous,” he says. “They will kill people.”
Addressing patient concerns
Now that the federal government says some pediatric vaccines are no longer routine, some physicians report that parents are concerned that their children can’t get them. “So many people are scared that their baby won’t get the hepatitis B vaccination at birth,” reports Jennifer Chin, MD, an OB-GYN at the University of Washington Medical Center. “They say they still want it, but they worry that it no longer being recommended nationally means that UW will no longer offer it to babies. I see fear in my patients’ eyes when they are asking for that.” (The UW Medicine system follows standard evidence-based guidelines and continues to provide the hepatitis B vaccine, which has been shown to reduce infections by 95% in infants.)
While vaccine policy has borne the brunt of Sec. Kennedy’s changes, it is not the only misinformation coming out of the CDC. Last September, with President Donald Trump at his side, Kennedy warned doctors not to give pregnant women Tylenol, claiming that it could lead their unborn children to develop autism. A review published last January in The Lancet Obstetrics, Gynaecology, & Women’s Health of existing studies found no correlation between the painkiller and autism.
“There’s no evidence that it will cause autism in your baby,” says Dr. Chin. “There are very limited options for pain medicine in pregnancy, and if we eliminate that, it will leave patients needlessly suffering with very normal parts of pregnancy, like headaches and joint aches.”
Yet, says Dr. Chin, the steady stream of misinformation has led patients to ask questions. “Even patients that I have a long-term relationship with and whom I consider to have high health literacy and the ability to differentiate myth from fact are saying, ‘I just wanted to double check because I don’t want to cause any harm.’ “
Sara Cate, MD, a family physician in Yakima, says that patients have forgotten how vaccines save lives and now are more apt to respond accordingly when offered them. She recalls a mother and child who were offered a flu vaccine booster. Instead of making a decision for him, the mother asked her son if he wanted the shot, and unsurprisingly the boy said he didn’t.
“That child can’t make that decision for himself. I juxtapose my 101-year-old mother’s experience with what is happening now,” says Dr. Cate. “In her day, she would go back to school in September and there would be empty chairs” from schoolmates who had died.
Exacerbating existing problems
Dr. Chu notes that vaccine skepticism that led to the current policies had been growing long before last year. “The tearing down has been gradual,” she says. “It’s not just that a switch was flipped in January 2025.” Indeed, childhood vaccination rates in Washington had already been on the decline before the latest moves by HHS. For example, in 2023, 78% of two-year-olds received all four doses of the DTaP vaccine. In 2020, the number was 86%.
A strong doctor-patient relationship is essential to combatting misinformation and helping keep patients safe. “Patients are coming to us scared and confused and hopefully we have the language and the skills not only to provide the standard-of-evidence care but also treat them with compassion and develop therapeutic relationships with them so that they know to come to us for trusted, true information,” says Dr. Chin.
Providing tools to combat misinformation and hesitancy will help. “The different medical societies have to come together as one voice and share resources to take over the role the CDC played,” says Dr. Cate. Even before the current administration took office, work was underway to bolster trust in the medical profession. The WSMA, in partnership with the American Medical Association, launched the Your Care Is at Our Core social media campaign in October of 2024 to highlight the importance of the patient-physician relationship and to begin restoring trust.
But strong relationships with patients have also been declining, driven by the response to the COVID-19 pandemic. “Trust in our profession has eroded in the past years because people have lost sight of the importance of data,” says Dr. Bush. “We saw this during COVID where people questioned when masking guidance changed. They accused the physician community of reversing course, when really we were working with the data and best evidence we had at the time. As we gained more experience with the disease and more data was collected, guidance evolved. Now we have to work hard to repair that trust.”
Dr. Chu says that in retrospect medical leaders bear some responsibility for inadvertently feeding people’s fears. “It makes us think about an acknowledgement of some of the things we didn’t do right in COVID and have a little more humility around that.” For example, she expresses concern that scientists downplayed the reports of myocarditis in young men as a rare adverse event from the vaccine. “We should have taken that a little more seriously,” she says. She also says that scientists should have recommended opening schools sooner.
The ongoing backlash from decisions made during the pandemic obscures the fact that in key ways the response was largely a success. “The real win from COVID was that we were able to get a vaccine together so quickly and save so many lives,” says Dr. Chu. “Five years later, we’ve forgotten how many people died and how extraordinary an achievement the vaccine was. That’s what’s shocking.”
In the meantime, Sec. Kennedy has accused doctors of being motivated by greed, adding yet another layer of distrust in the physician community. The lie infuriates Dr. Melnick.
“That’s the biggest bunch of bullshit,” he says. “My god, you’re not getting a deal from Big Pharma each time you give a shot.”
In addition to rebuilding trust with patients, doctors also have to deal with everyday pressures, especially time and billing. Conversations take time, which is in short supply and isn’t generally reimbursable. (It is also not a metric upon which physicians have their performance evaluated.)
“It just takes longer and longer to have those conversations because of the amount of general skepticism and the fact that there is now a national platform for discussions that used to be in the shadows,” says Dr. Chu.
That adds to the stresses that physicians are already under. “We have very limited time with patients, and often it is hard for patients to access care,” says Dr. Chin. “If half the visit is taken up talking about misinformation, that leaves us little time to do routine medically necessary care. We either need to delay that counseling until our next visit, or we need to cut into time that we should be spending with another patient.”
While health plans continue to offer coverage for all the childhood vaccines regardless of the CDC’s recommendations, Dr. Chu wonders how long that will last. “Right now, America’s Health Insurance Plans [AHIP, the trade organization for the industry] will follow the pre-Trump vaccination policy, at least in terms of payment,” she says. “But at some point, that will have to be discussed.”
Meanwhile, the country is bearing unnecessary costs that are likely to grow, says Dr. Melnick.
“People shouldn’t be getting measles in the U.S.” he says. “We are spending all our time on things that are completely preventable and that shouldn’t require major intervention from us when we could be spending time on other areas with our communities and our patients.”
It’s not just suffering and mortality that could have been avoided. The potential for more outbreaks of preventable disease is going to be expensive and a drain on already limited resources.
“It cost our health department more than $800,000 for the measles outbreak in 2019,” says Dr. Melnick, adding that the total cost, including time from volunteer physicians and lost productivity, was in the millions. “Those are opportunity costs that are lost in terms of providing other services to our patients.”
Standing for science
Faced with the threat to public health and, more broadly, to evidence-based medicine, physician organizations, including the WSMA, are responding with extraordinary efforts to counter the federal government’s actions. Physician groups have been leaders in rebutting the misinformation coming out of HHS and in condemning the dismantling of public health infrastructure. Last September, the WSMA joined more than 50 specialty societies and nonprofits in publicly calling for Sec. Kennedy’s resignation, the only state medical association to do so. The WSMA also successfully sued HHS last year to stop discriminatory federal deletions of taxpayer-funded health data.
“Our medical partners, including WSMA, are rising to the occasion,” says Dr. Melnick. “If we didn’t have the WSMA, the American Academy of Pediatrics, the American Academy of Family Physicians, the American College of Physicians, and the American College of Obstetricians and Gynecologists, it would be a lonely position to advocate for this. It shouldn’t have been necessary, but it is nice to know that we are all working on this together.”
States have also joined the battle. Washington, Oregon, California, and Hawaii have formed the West Coast Health Alliance, which was created “to uphold the integrity of effective public health strategies that protect the health of our communities,” including vaccine recommendations. In many ways, decisions are returning to the way things were before ACIP was formed more than 60 years ago to harmonize a patchwork of vaccination recommendations across the nation. (At the time of this writing, the AMA announced the Vaccine Integrity Project, a collaborative effort to reinstate a structured, evidence-based process to assess vaccine safety and effectiveness for the 2026–27 respiratory virus season.)
A bill being considered in the state Legislature would clarify state authority, allowing the state Department of Health to make recommendations for immunizations and, more broadly, preventive services using evidence-based recommendations from outside experts. “The goal is to ensure that anyone who wants to get vaccinated can still access them and is covered by their health insurance,” says Malorie Toman, lobbyist for the WSMA, which is part of the coalition to help to shape and support the measure. The measure echoes language in a resolution passed by the WSMA House of Delegates at its meeting last September.
Dr. Bush says that the WSMA must be at the forefront of the current battle over medical standards.
“The WSMA as an arm of organized medicine exists to protect evidence-based practice,” she says. “We exist to protect our physicians from threats against them giving the best possible care to our patients. Medicine changes not because of trends and personal philosophies but because science is rigorous in its effort to continue to improve. When guidelines change without the data to support the change, it puts patients at risk. We cannot say we are doing our best patient care when data doesn’t support our actions.”
An uncertain future
Despite the best efforts of medical societies and physician leaders, the damage caused by the federal government seems likely to continue. The U.S. Preventive Services Task Force, which makes recommendations for screenings, counseling, and preventive medications, has not met since shortly after Sec. Kennedy took office amid rumors that he wants to shut it down. Like ACIP, the task force is supposed to be an independent panel of experts who study the evidence to make recommendations, which in turn are included by health plans in their insurance policies.
Despite everything, Dr. Chu remains cautiously optimistic that at some point the federal government will return to relying on evidence as the basis for decisions. “I’m pretty hopeful that this isn’t permanent,” she says. “I don’t think the way decisions are being made now is going to be long term. I do think there’s a sense of ‘let’s wait this out.’ I don’t think it’s so destroyed that it can’t be rebuilt.”
While Dr. Cate, who also holds a master of public health, believes that the current situation is temporary, as well, she laments the damage that continues to be done. “I am concerned about the loss of lives,” she said. “We had one of the most wonderful public systems in the world. It’s just heartbreaking.” Yet, she says she will continue to do what she’s always done: “I’ll keep teaching and providing evidence-based care and develop relationships with patients so that they trust me.”
John Gallagher is a freelance writer specializing in health care.
This article was featured in the March/April 2026 issue of WSMA Reports, WSMA’s print magazine.