Vaccine Shortages. Viral Outbreaks. Widespread Illness. More Death.

It’s Sep­tem­ber 2026. Rou­tine child­hood vac­cines are now option­al in the Unit­ed States, and gov­ern­ment offi­cials, after hasti­ly com­pil­ing an immense research reg­istry of autis­tic peo­ple, have added the neu­rode­vel­op­men­tal con­di­tion to the list of com­pens­able vac­cine injuries, there­by open­ing up vac­cine mak­ers to an onslaught of law­suits. Fac­ing decreased demand and increased lit­i­ga­tion, some vac­cine mak­ers have pulled their shots from the domes­tic mar­ket entire­ly. Out­breaks are spread­ing across the coun­try, sick­en­ing tens of thou­sands of peo­ple; too many are dying, espe­cial­ly chil­dren, preg­nant peo­ple, and old­er adults. Some­thing sim­i­lar is unfold­ing around the world because the U.S. gov­ern­ment end­ed vac­ci­na­tions for mil­lions glob­al­ly.

This is one sce­nario Amer­i­ca faces if we con­tin­ue down the path being bush­whacked by Robert F. Kennedy Jr. and oth­er anti-vac­cine activists at the Depart­ment of Health and Human Ser­vices. And when I called up vac­cine experts to ask whether my dystopi­an fears made me a doomer, they agreed that this grim sce­nario was plausible—and that it could get even worse.

Every day seems to bring more omi­nous news about Kennedy’s war on vac­cines. With­in just the past few weeks, Kennedy has done the fol­low­ing: He abrupt­ly fired all 17 mem­bers of the CDC’s Advi­so­ry Com­mit­tee on Immu­niza­tion Prac­tices, known as ACIP, and replaced them with large­ly inex­pe­ri­enced peo­ple, some of who are out­right anti-vac­cine activists—who then prompt­ly vot­ed to ban thimeros­al, a rare but safe preser­v­a­tive, from flu vac­cines. He changed CDC rec­om­men­da­tions so that they no longer say healthy chil­dren and preg­nant peo­ple should receive Covid-19 vac­cines. And he announced the U.S. would stop fund­ing Gavi, an inter­na­tion­al orga­ni­za­tion that vac­ci­nates chil­dren around the world.

“It’s hard to know how this is all going to play out. But right now, every­thing appears very dark,” said Peter Hotez, dean for the Nation­al School of Trop­i­cal Med­i­cine at Bay­lor Col­lege of Med­i­cine. And yet, he added, “I don’t think we’ve hit bot­tom. I think he’s con­tin­u­ing to chip away, with some pret­ty big chips, to erode our vac­cine ecosys­tem. I don’t see a turn­around at this point. We’re still in free fall as far as I’m con­cerned.”

I’m not the first to try to gaze into a crys­tal ball about the future of vac­cines in Amer­i­ca. In Jan­u­ary 2025, at Kennedy’s con­fir­ma­tion hear­ing, Sen­a­tor Eliz­a­beth War­ren began rat­tling off the actions he could take as sec­re­tary, giv­en his his­to­ry of prof­it­ing from law­suits against vac­cine mak­ers:

The bot­tom line, War­ren added: “Kennedy can kill off access to vac­cines and make mil­lions of dol­lars while he does it. Kids might die. But Robert Kennedy can keep cash­ing in.”

Sure enough, some of this has come to pass. In an X video in May, Kennedy announced that the CDC was chang­ing its rec­om­men­da­tions for the Covid vac­cine. The agency turned the child­hood rec­om­men­da­tion from “should” to “may” and called the process “shared clin­i­cal deci­sion-mak­ing,” while elim­i­nat­ing the rec­om­men­da­tion entire­ly for preg­nant peo­ple, who are at sig­nif­i­cant­ly high­er risk for severe ill­ness and death.

I asked the experts: Could oth­er vac­cine rec­om­men­da­tions be soft­ened like this? “I think it’s a real possibility—I think in many ways it’s a goal,” said Paul Offit, pro­fes­sor of pedi­atrics at the Uni­ver­si­ty of Penn­syl­va­nia Perel­man School of Med­i­cine. Project 2025, the right-wing blue­print for the sec­ond Trump admin­is­tra­tion, specif­i­cal­ly called for elim­i­nat­ing the CDC as a rec­om­mend­ing body. If a vac­cine is no longer rec­om­mend­ed, “that means that it couldn’t be required for school entry.” (School man­dates have long been a tar­get of anti-vac­cine activists.)

Oth­ers thought it might be even worse. “[Kennedy’s] end goal is to remove most or all child­hood vaccines—to make them inac­ces­si­ble, is my view,” said Dorit Reiss, pro­fes­sor at UC Hast­ings Col­lege of Law. “So your sce­nario is plau­si­ble, although you’re being very cau­tious in say­ing they might move to shared clin­i­cal deci­sion-mak­ing. They could say ‘this is no longer rec­om­mend­ed.’” The new ACIP advis­ers could stop rec­om­mend­ing some vac­cines entire­ly: HPV, influen­za, and hepati­tis B shots have all been tar­get­ed by anti-vac­cine activists. They could also vote to end Vac­cines for Chil­dren, a $5 bil­lion pro­gram cov­er­ing the vac­ci­na­tions of near­ly half of all chil­dren in the Unit­ed States

The admin­is­tra­tion may also make it dif­fi­cult to approve new vac­cines. “It’s not only about Kennedy’s insis­tence on saline place­bos,” Hotez said, refer­ring to the health secretary’s announce­ment in May that vac­cines would need to go through new, uneth­i­cal clin­i­cal tri­als involv­ing place­bo tests. “There’s so lit­tle vac­cine exper­tise now, either at FDA because peo­ple seem to be leav­ing, and with ACIP, there’s almost no vac­cine exper­tise in its cur­rent group.”

And, of course, there’s the harm that fig­ures like Kennedy do with pub­lic advo­ca­cy against vac­cines. That includes the ACIP advis­ers’ rec­om­men­da­tion on Thurs­day to remove thimeros­al, a preser­v­a­tive used only in mul­ti­dose vials of flu vaccines—about 4 per­cent of all flu vac­cines giv­en in the U.S.—in order to pre­vent bac­te­r­i­al and fun­gal infec­tions. Thimeros­al was removed from all oth­er child­hood vac­cines in 2001 as a pre­cau­tion when anti-vac­cine activists first began link­ing it to autism—a con­nec­tion that mul­ti­ple stud­ies have dis­proven. Ban­ning it entire­ly now could under­mine American’s sense of vac­cines’ safe­ty and neces­si­ty.

In June, Health and Human Ser­vices award­ed $150,000 to the Ari­zona law firm Brueck­n­er Spitler Shelts for its legal “exper­tise” on the Nation­al Vac­cine Injury Com­pen­sa­tion Pro­gram, which is run by the Health Resources and Ser­vices Admin­is­tra­tion, a sub­agency of HHS. Drew Down­ing, a lawyer at the firm, has a rep­u­ta­tion for rep­re­sent­ing peo­ple who say they’ve been injured by vac­cines, and he has been involved in law­suits against vac­cine mak­ers. Sev­er­al of the new advis­ers on ACIP have also served as expert wit­ness­es in law­suits against phar­ma­ceu­ti­cal com­pa­nies.

“I think [Kennedy’s] goal is to either remove vac­cines from the vac­cine injury com­pen­sa­tion pro­gram or add to the list of com­pens­able injuries, all of which will weak­en the vac­cine infra­struc­ture,” Offit said. Autism, for exam­ple, could be added to the list of injuries based on the administration’s fast-tracked research to find a link between the con­di­tion and vac­cines, despite decades of sci­en­tif­ic research show­ing oth­er­wise. Changes to the com­pen­sa­tion pro­gram could mean vac­cine mak­ers sim­ply choose to stop mak­ing shots avail­able in the U.S., Offit said: “Make vac­cines expen­sive enough, or make them more sub­ject to friv­o­lous lit­i­ga­tion, and they’ll leave.”

Some­thing sim­i­lar has hap­pened before. In 1980, 18 com­pa­nies made vac­cines; by 1990, that num­ber had fall­en to four. A 1981 study sug­gest­ed that the whole-cell per­tus­sis com­po­nent of the DTP vac­cine could in rare cas­es cause per­ma­nent brain swelling. Sub­se­quent stud­ies found no such link; in fact, the swelling was caused by infant epilep­sy. Even so, lit­i­ga­tion against per­tus­sis vac­cine mak­ers and then man­u­fac­tur­ers of all vac­cines began to mount, caus­ing vac­cine prices to sky­rock­et and push­ing some man­u­fac­tur­ers out of busi­ness. Faced with a volatile vac­cine mar­ket, Con­gress passed a law in 1986 lead­ing to the cre­ation of the Nation­al Vac­cine Injury Com­pen­sa­tion Pro­gram.

“If you real­ly want to hurt vac­cines, mess with the vac­ci­na­tion com­pen­sa­tion pro­gram,” Offit said. After all, vac­cines aren’t usu­al­ly a big pay­day for phar­ma­ceu­ti­cal com­pa­nies, he said. “They make mon­ey on things that you give fre­quent­ly. They don’t make as much mon­ey as things that you give once or a few times in a life­time.”

The vac­cine mar­ket is big, but for phar­ma­ceu­ti­cal com­pa­nies, “vac­cines are still a very mod­est com­po­nent of their rev­enue com­pared to all the small mol­e­cule drugs that they’re pro­duc­ing,” said Hotez. Fac­ing lit­i­ga­tion, com­pa­nies might decide vac­cine pro­duc­tion isn’t worth it. “If it becomes unten­able for them to remain in the U.S. mar­ket, they may just pull the plug on their vac­cine side alto­geth­er.”