US Medical Care Set to Fracture Over MAHA as States and Physicians Groups Break With Administration Recommendations, Plan to Fund Own Research

The Jimmy Kimmel show seemed to be an odd battleground to wage a successful First Amendment war. Apparently the free speech rights of celebrities are more important than those of Israel genocide protestors.¹ But another, longer-term, less visible battle has begun between medical organizations and state public health officials who are not on board with the Administration and in particular, its efforts to raise doubts about certain vaccines and medications and even restrict access to some by no longer recommending them. As we saw with Covid shots, the CDC ending its recommendation for an annual jab didn’t just lead to insurers not covering them but major pharmacy chains not stocking them. Now that the CDC has adopted the half-pregnant “personal choice” stance, states are trying to figure out what that means. But the shots do seem to be available again at major pharmacies.²

Soon below, we will discuss in some detail a Wall Street Journal article, The Doctors Building a Public-Health Universe Outside the Government. It describes how key medical associations and some states are bucking the new Federal recommendations, particularly with respect to vaccines. Perhaps even more important, they are seeking to fill a data void that historically had been filled by the CDC.

The latter focus, on being a data warehouse and potentially a clearinghouse/distributor of treatment recommendations, if done well, could give this initiative the chops to indeed constitute a parallel public health system. We had severely criticized Biden CDC head Rochelle Wallensky for clearly not having the experience to run a 32,000 employee organization, whose major duty had been to be an information shop for clinicians. The CDC massively dropped the ball on Covid via its failure to give front-line physicians guidance, particularly treatment guidelines, as it had done very effectively during AIDS.

A second issue is, if states split on vaccination guidelines, which is already underway, how insurers respond. There are already far too many case of insurers refusing to pay when state law says otherwise;³ they seem to make a point of not implementing state-specific requirements well.

But third is that we are also in a period when medical care is being split ever more on class and ideological lines. The big driver of MAHA is very affluent health conscious patients (and more important, the doctors and product providers who cater to them) who are often keen about alternative medicine and fetishistic about food purity, someone most dull normal consumers cannot readily access⁴ or afford if they could. Many of them reject all or part of conventional medicine. Recall Steve Jobs refusing to get a conventional treatment for his highly treatable pancreatic cancer based on his undue faith that he could beat it with “natural” methods.

Now it is also true that the skepticism among this elite cohort has some foundation, even before the abysmal failure to get adequate data on Covid vaccine injuries and craft vaccination policies that allowed for informed consent.⁵ Overtreatment and overtesting are widespread in American medicine.

Sadly on the vaccine front, this polarization of views has led to black/white position where neither is optimal. For instance, with the CDC considering changes to the pediatric vaccine schedule, one candidate for removal was the immediately-after-birth Hep B vaccine. Bill Cassidy, the Republican chair of the Senate Committee on Health, Education, Labor and Pensions had forcefully defended this vaccination in recent hearings, with the result that an advisory committee that was expected to vote against it instead postponed its vote.

This story is not as straightforward as one might think.  As The Conversation pointed out:

Before the United States began vaccinating all infants at birth with the hepatitis B vaccine in 1991, around 18,000 children every year contracted the virus before their 10th birthday – about half of them at birth. About 90% of that subset developed a chronic infection.

In the U.S., 1 in 4 children chronically infected with hepatitis B will die prematurely from cirrhosis or liver cancer

However, the counter-argument is that ob/gyns test pregnant women regularly, and that it would be comparatively easy to check them for Hep B, and vaccinate only those babies who were at risk.

But that presupposes adequate care. The US already has the highest maternal death rate among affluent countries. 7% of live births are to mothers who received late or no prenatal care. The US had over 3.6 million live births in 2024. 7% of that is 252,000. It’s not hard to imagine, given the gaping holes in US pre-natal care, that a lot of these mothers would not be well tested, if at all.

In other words, I would take the anti-vaxxers a lot more seriously if they pumped aggressively for more extensive prenatal treatment and also educated doctors as well as the women seeing their ob/gyns to get tested for Hep B and administer the vaccine to newborns only if indicated. But I have yet to see any Hep B vax-after-birth objector making this sort of proposal in a public venue.

Nevertheless, what seems to be baked in is even more ideologically-driven practice of medicine. This will only increase patient distrust and confusion, as well as the potential for additional doctor and patient stress due to more fights with insurers over conflicting Federal v. some state guidelines.

Now to key sections of the Wall Street Journal account:

A growing contingent of doctors and policymakers say they have grown wary of federal health guidance since longtime vaccine skeptic Kennedy became Health and Human Services Secretary—and they are forming a parallel public-health universe outside the U.S. government.

Professional medical societies are releasing guidelines that depart from the government’s stance. Governors and state health officials are changing rules to ensure access to vaccines within their borders.

At the nucleus of the effort is an initiative that [Dr. Daniel] Crawford [past president of the National Association of Pediatric Nurse Practitioners ] mentioned as a new trusted expert: the Vaccine Integrity Project, a group of public-health veterans and researchers who have banded together to sift through and analyze the latest studies on vaccines.

The article describes the focus on vaccines and now allegedly acetaminophen (Tylenol) as causes of autism as the bloody flag for RFK, Jr. and his fellow travelers. We’ve described repeatedly that autism is not a post-natal condition. The most likely cause for the rise in autism is changes in criteria, with the result that far more children are classified as autistic than before, and mothers giving birth at older ages.

We then get to the battle in progress:

The resistance has been building since Trump tapped Kennedy and said he told him to “go wild on health.” In May, Kennedy posted a video on X announcing the removal of a Covid-19 vaccine recommendation for pregnant women and healthy children….

In June, Kennedy removed all 17 members of the Advisory Committee on Immunization Practices, or ACIP—the panel that met last week—and replaced them with a team that includes vaccine skeptics. Distrust reached a boiling point at the end of August, when the Trump administration ousted the CDC’s newly sworn-in director, Susan Monarez, following clashes over vaccine policy with Kennedy.

Last week the new ACIP team—including several members appointed just a few days earlier—dialed back the government’s strong recommendation of the Covid vaccine, advising instead “individual decision-making” with a physician, nurse or pharmacist. The advisers also removed the government’s recommendation of a combined vaccine for measles, mumps, rubella and varicella, or chickenpox, for children.

The varicella vaccine is a live virus vaccine which can lead to stronger reactions, including more susceptibility to near-term infection (live virus vaccines, however, also confer a longer-term general immune system boost). And in general, the US is way too gung ho on administering multiple vaccines at once for the convenience of medical practitioners. So spacing them out is not a crazy idea, but no foundation was laid for this proposal.

And to the consequences, of inconsistent responses across insurers, and resistance:

Private insurance plans normally use ACIP recommendations to guide their coverage. Some insurers have signaled they would continue to cover vaccines that were recommended before the changes last week.

Doctors and other healthcare professionals protested the vote outcomes and the new ACIP’s departure from traditional procedures for weighing evidence based on a labor-intensive evaluation of the latest research.

The Infectious Diseases Society of America reacted in real-time. “Scientific evidence continues to strongly support broad COVID-19 vaccination,” the group posted on X. It also posted: “.@SecKennedy presents a clear and present danger to the American people and their families.”….

Early this month, several states broke with the CDC on vaccine policy. Some formed coalitions to come up with their own public-health guidance.

“We have to step up as governors to do this because the federal government is not a trusted partner right now,” said Gov. Tina Kotek of Oregon, one of four states in a newly formed group they call the West Coast Health Alliance. The alliance issued guidelines for the Covid, RSV and flu vaccines for the fall season a day before the ACIP met.

However, the leaders of the Vaccine Integrity Project include Michael Osterhelm of the University of Minnesota’s CIDRAP, which has been a very reliable source of information on Covid….and Rochelle Wallensky. The latter one assumes is meant to bolster confidence among the true-blue. It will backfire with a lot of fence-sitters, particularly if she’s used as a spokescritter. However, the Journal focuses on Osterhelm, highlighting his role as the moving force and suggesting he will be the face of this initiative.

Christy Walton has provided $246,000 in seed funding. The mission so far:

Osterholm and his team canvassed health organizations, medical societies, hospital systems and others, asking: If the CDC and ACIP were to be seriously compromised, what could Osterholm’s group do to help them with vaccine recommendations?

They reviewed the responses with a steering committee made up of public-health leaders, former Republican Gov. Asa Hutchinson of Arkansas and a former Republican congressman. Ultimately, they decided that the best thing they could do was research—the kind the CDC normally provides to these groups.

The story describes at length the credentials and efforts made by other senior member of this effort. And they are already swinging into gear:

In August, a virtual audience logged into a webinar to hear the results of the project’s research on fall shots. Doctors and researchers presented their findings.

“What you’re about to hear is an analysis typically done by CDC,” said Osterholm. The webinar now has more than 9,000 views.

It is way too early to tell how effective this initiative to fill in the chasms that have emerged in CDC information will fare. I don’t like invoking libertarian phrasemaking. But to the right wingers who object to pushback against MAHA, pray tell, how can you oppose competition in the market for ideas?

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¹ The lawyers in the house can no doubt make the point more precisely, but it was not Kimmel’s free speech rights that were restricted. Kimmel operating in his capacity as an Disney/ABC employee is subject to whatever his contract allows regarding his content, and one can be confident it does place limits on what he can say. It was ABC that was the recipient of pressure and ABC that initially folded.

² I don’t like having to weigh in but failing to do so will lead to undue squawking in comments. Yours truly is not a fan of the mRNA vaccines. Among other things, the immunity boost they confer is short lived at best and often not operative due to the continued mutation of the virus. Unfortunately, the fight over this technology has had the effect of strengthening the de facto campaign against the use of Novavax, which is based on a different technology that is older and safer than mRNA and also confers more durable immunity.

Two additional elephants in the room: the fixation on vaxxing has been a big contributor to continued high baseline Covid rates in the US due to failure to implement other preventive measures, above all better ventilation and masking. And the demonization of mRNA as a vaccine is leading to prejudice against its use as a cancer therapy, which is a completely different application.

³ For instance, in the Covid era, New York State required that Covid tests be reimbursed. Recall there was a period when airlines required a recent negative Covid test in order to fly. Cigna refused to pay out on these claims and I repeatedly had to get the state insurance regulator on them.

⁴For instance, one can meet the cow that will be your later source of beef and even specify what type of grass it will eat before slaughter.

⁵ I know personally of 2 cases of vaccine injuries that were not reported to VAERS. IM Doc also described, repeatedly and contemporaneously, of how his reports of injuries, which included ones that were severe, in particular a death, were more often than not rejected. My impression that only about 1/3 were accepted. So the VAERS database is not even remotely reliable as a guide to the level of Covid vaccine injuries.