On the same day that Health Secretary Robert F. Kennedy Jr. ousted Centers for Disease Control and Prevention (CDC) Director Susan Monarez, the Food and Drug Administration (FDA) approved significant new restrictions on COVID vaccines. 

Specifically, only those 65 and older, or younger people with at least one medical comorbidity that puts them at increased risk of severe disease, are now eligible to receive them. These restrictions await approval from the CDC’s Advisory Committee on Immunization Practices (ACIP), with approval all but certain given that Kennedy has previously fired all 17 ACIP members and replaced them with a majority of anti-vaccine allies.

The effects of these restrictions are immediate and severe. Facing the threat of legal retribution, many pharmacies across the country are already requiring prescriptions from doctors for anyone seeking vaccination. In some states, pharmacies have ceased offering doses altogether, further narrowing access. Insurance uncertainty means that for those able to obtain a prescription, the out-of-pocket cost for a COVID booster can reach $150 per dose. Even for individuals seeking off-label use, “doctor shopping” is becoming the norm, with physicians themselves facing the threat of sanction from their boards or state medical authorities for issuing scripts.

Pharmacy giants CVS and Walgreens have restricted vaccine access in more than a dozen states. CVS spokesperson Amy Thibault confirmed that vaccines would not be available in their pharmacies across 16 states, citing the “regulatory environment” imposed by recent policies. As of Friday, 13 of these 16 states, including the District of Columbia, now require a prescription from a licensed provider; in Massachusetts, New Mexico and Nevada, the shots cannot be offered at all.

These political restrictions will have disastrous consequences for public health as the country heads into the fall and winter waves of the pandemic.

The Pandemic Mitigation Collaborative has been unable to update its models since August 11 due to changes imposed on CDC data, but as of their last update, approximately 700,000 Americans were becoming infected daily with SARS-CoV-2. This rate amounts to between one and four million COVID cases and 7,900 to 13,100 excess deaths in September alone.

Annually, some 50,000 to 60,000 people continue to die from COVID or COVID-related complications. Long COVID, affecting at least 6 percent of those infected, brings chronic illness comparable to that caused by stroke, rheumatoid arthritis or Parkinson’s.

The broader attack on science was given a violent expression earlier this month, when a gunman unleashed more than 500 rounds of ammunition into the CDC’s Atlanta campus, killing a police officer and then himself. The assailant, Patrick Joseph White, suffering from severe depression and suicidal ideation, blamed the COVID vaccine for his condition—beliefs encouraged by the anti-vaccine, anti-science rhetoric for which Kennedy and his ilk are notorious.

These forces have worked not only to shift the blame for the pandemic destruction from governmental neglect to public health officials and scientists, but also to foster an atmosphere in which such acts become increasingly possible. Kennedy’s response to the shooting—remaining silent for more than 18 hours and instead posting fishing trip photos to social media—sparked outrage among CDC employees. When an official statement was finally released, it was widely condemned as tepid and inadequate.

Monarez’s ousting followed a show-down where she refused to implement Kennedy’s demand that she rubber-stamp all recommendations from his newly assembled anti-vaccine ACIP board and to purge high-level staff from key posts. Principal Deputy Chief of Staff Stefanie Spear demanded her resignation, and by Wednesday, HHS issued a perfunctory statement that Monarez was “no longer director of Centers for Disease Control and Prevention.” 

With yesterday’s White House announcement that Jim O’Neill, Kennedy’s current deputy and a former Silicon Valley tech investor, would replace Monarez, Kennedy has consolidated control over the public health system, transforming these institutions into bastions of anti-scientific thought and presenting an existential threat to public health and safety.

Dr. Robert Steinbrook, director of Public Citizen’s Health Research Group, summed up the sentiment among public health experts:

Ousting the first Senate-confirmed CDC director weeks into the start of her tenure makes absolutely no sense and underscores the destructive chaos at RFK Jr.’s Department of Health and Human Services. To make matters even worse, there are reports of additional resignations of critical high-ranking CDC staff. The CDC is being decapitated. This is an absolute disaster for public health.

In solidarity with Monarez, four other long-serving public health leaders have resigned: Dr. Debra Houry, CDC chief medical officer; Dr. Demetre Daskalakis, director of the National Center for Immunization and Respiratory Diseases; Dr. Daniel Jernigan, director of the National Center for Emerging and Zoonotic Infectious Diseases; and Dr. Jennifer Layden, head of the Office of Public Health Data, Surveillance and Technology.

On the New York Times’ podcast, Dr. Daskalakis revealed that neither he nor his staff, who advise on vaccines, had ever met with Kennedy since he became Health Secretary, nor had they been consulted on major issues surfacing under his tenure, such as the measles outbreak in Texas and elsewhere. He only learned of Kennedy’s previous restriction on children’s access to COVID vaccines through social media, having not been consulted whatsoever.

Daskalakis stated in no uncertain terms:

My job is to make sure that we’re giving good science so people can make good decisions. And if I can’t make sure that science is untouched by non-scientific influence, I cannot say that I’m doing my job. I believe that CDC science is going to be compromised by HHS. And if that science becomes biased, if it gets unduly influenced, then I can’t have my name on that science as something that I think should be used to make important decisions for people’s lives.

In the discussion, Daskalakis explained that Kennedy would use the CDC and their database to manipulate or make inaccurate in a manner that doesn’t reflect scientific reality for his political agenda. This will further tarnish the reputation of scientists and public safety in numerous ways and reverse much of the scientific gains that have been amassed over decades of deeply collaborative work.

Daskalakis’ resignation letter provides a social and political background to Kennedy’s deepening coup on science:

The intentional eroding of trust in low-risk vaccines favoring natural infection and unproven remedies will bring us to a pre-vaccine era where only the strong will survive and many if not all will suffer ... Eugenics plays prominently in the rhetoric being generated and is derivative of a legacy that good medicine and science should continue to shun.

The recent shooting at CDC is not why I am resigning. My grandfather, who I am named after, stood up to fascist forces in Greece and lost his life doing so. I am resigning to make him and his legacy proud. I am resigning because of the cowardice of a leader that cannot admit that HIS and his minions’ words over decades created an environment where violence like this can occur. I reject his and his colleagues’ thoughts and prayers, and advise they direct those to people that they have not actively harmed.

Kennedy’s consolidation of power over the institutions of science will have untold consequences. The new restrictions on COVID vaccines are only the latest chapter of a far-reaching attack on public health which threatens to undo decades of progress and endanger millions of lives globally.