I (Izzy) have always called this week my limbo week, the stretch that sits uncomfortably between the last “carefree” days of summer and the excitement of getting back into a school year routine.

U.S. vaccine policy remains in its own sort of limbo, a limbo era, if you will. We paused this series last week to bring you a view from 30,000 feet, so we’re picking back up with a lot to cover: Updated COVID vaccines have been approved and are shipping, four of the country’s largest medical societies issued joint fall recommendations without the Centers for Disease Control and Prevention’s (CDC’s) advisory committee, and the CDC publicly disputed Pennsylvania’s report of two measles deaths and pulled them from the national tally.

For most of our lifetimes, three separate questions had a single answer, and that answer was the CDC. What vaccines are recommended, whether you can walk in and get one, and what’s actually happening with disease in this country were all things you could look up in one place. This fall, those three questions have three different answers, and none of them are the CDC. Recommendations are coming from professional societies. Access depends on your state and your pharmacy chain. Even the disease counts are contested between the federal government and the states reporting them.

As someone who collaborates with a great team to put this piece together for you every two weeks, I’d hoped, probably naively, that we’d be further along on the American Academy of Pediatrics (AAP) v. Kennedy legal front by now. I know these things take time, and I’d rather wait for the right decision than a rushed one, but for the millions of Americans trying to figure out which organizations to believe and which vaccines to get, the longer this drags on, the more confusion it causes. Most of what we’re hearing from readers right now comes from looking in the old place and finding either nothing, or something that conflicts with what their own doctor told them.

So, what actually happened, and what does it mean for getting your family vaccinated this fall?

Let’s discuss…

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So Who’s Actually In Charge of Vaccine Recommendations Right Now?

The question is a valid one. Yesterday, joint recommendations were issued by the AAP, American College of Obstetricians and Gynecologists (ACOG), American Academy of Family Physicians (AAFP), and Infectious Diseases Society of America (IDSA) for the upcoming 2026-27 respiratory season. The recommendations were posted to a new American Medical Association (AMA) site called SpreadTheFacts.org, with more detailed scientific reasoning published in their peer-reviewed journal, JAMA.

This work used to happen in partnership with the CDC’s ACIP, but the collaboration ended in June 2025 when committee membership was wiped, and both committee actions and membership remain on hold while the legality of the moves plays out in court.

In the absence of an existing (and functional) federal backbone, these societies commissioned their own review of current evidence through the University of Minnesota’s Vaccine Integrity Project (part of CIDRAP), working alongside the AMA. Each society published guidelines for their respective patient populations.

• Flu: Recommended for everyone six months and older, and October is ideal (flu before boo). Adults aged 65 and older should preferentially receive an enhanced vaccine (high-dose, adjuvanted, recombinant, or mRNA). If an enhanced vaccine is not available, the recommendation is to get what’s in front of you without delaying. The same can be said about the October window. Any dose of flu vaccine, even administered after October, is better than none.

• COVID: Adults 19 and older should receive an updated vaccine, with a second dose received six months later for adults aged 65 and older (AAFP). Children aged six through 23 months should receive an updated vaccine, and older children can receive the vaccine based on risk and parental preference (AAP). The vaccine is recommended during pregnancy and lactation in any trimester (ACOG). And finally, immunocompromised patients at least six months of age are recommended to receive both COVID and flu vaccines (IDSA).

• RSV: Adults 75 and older, and higher-risk adults aged 50-74 should get a single dose of the vaccine. For most adults, this is not an annual vaccine. Pregnant women can also receive the vaccine, meaning infants are protected either through maternal vaccination at 32-36 weeks, or through receipt of a monoclonal antibody after they are born.

There is one key change from last year. ACOG extended the window for pregnant women to receive the RSV vaccine (now September 1 through March 1), rather than stopping at the end of January. This is based on observations that RSV seasons have been trending toward beginning later in the respiratory season and running longer, so the updated window reflects those considerations.

These recommendations are broader than the Food and Drug Administration’s (FDA’s) approval criteria, and ultimately the approval is what determines what the manufacturer can market and what a pharmacist is allowed to administer. The recommendations are guidelines for what your clinician should offer you. And ultimately, those guidelines will vary based on where you live, as many states have legally ensured they can rely on vaccine recommendations outside exclusively the ACIP.

Updated COVID Vaccines Are Here. Can You Get One?

The FDA approved the updated 2026-27 COVID vaccines on August 27 for people aged 65 and older, as well as younger people with a condition that raises their risk of severe illness. FDA officials estimated last year that somewhere between 30% and 60% of Americans have a qualifying condition, and the list is long (asthma, diabetes, obesity, physical inactivity, pregnancy, cancer, immune deficiency, some mental illnesses, and a range of heart and lung conditions). And clinicians can vaccinate off label outside of the FDA approval.

The greatest complication is that most Americans get their COVID vaccine at a pharmacy rather than a clinician’s office, and pharmacists operate under state laws. Some of those laws explicitly tie a pharmacist’s scope of practice to a CDC recommendation (not the professional societies’). Walgreens says it will let people self-attest that they meet the criteria in every state except Arizona and Oregon, where a prescription is still required. CVS says its pharmacists will use “shared clinical decision-making” without confirming whether self-attestation counts. Walmart says it will require prescriptions in some states, but has not mentioned specifics.

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What we don’t know yet

We’ve gotten several questions, and a lot of them are still open-ended at this time. Our colleague Dorit Reiss has been tracking the legal side of all of this in detail, and we will link a state-by-state pharmacy breakdown as soon as a reliable one exists. Here’s where we stand right now:

1. Which states will end up requiring a prescription. The chain policies above are the chains’ own interpretations of the legality, and it has changed week to week in prior seasons.

2. Whether private insurance covers it. In the absence of a CDC recommendation, private insurers are not obligated to cover the vaccine. AHIP, the trade group that includes most major insurers, says its members will pay anyway, and UnitedHealthcare (not an AHIP member) says the same. Employer-sponsored plans can differ from their parent company, so we recommend checking your plan’s specifications before you go.

3. Vaccines for Children (VFC). Roughly half of American children get their vaccines through VFC, and the CDC ships those doses. Without a CDC recommendation, no one has said publicly whether those shipments will happen, and the Department of Health and Human Services (HHS), which oversees the CDC, has not answered questions about it. We have heard from sources we trust that COVID vaccines will in fact be available through VFC this season but can’t point to written documentation at this time. In the meantime, it’s always worth checking with your clinician to see what he or she can actually order,

4. How much of this is a moving target. Availability changed significantly around this time last year, so if your pharmacy’s schedule is showing no available appointments today, keep checking.

The Consequences of Childhood Vaccine Policy Whiplash

We went through the new kindergarten coverage numbers last week. In brief, exemptions from at least one vaccine rose to 4.2% from 3.6%, and coverage of the measles, mumps, and rubella vaccine fell to 92.4%.

The Pennsylvania story has moved considerably since we wrote about it. Two unvaccinated Lancaster County residents died after contracting measles in August, marking the state’s first measles deaths in 35 years and the first in the country this year. One was a newborn, and the county coroner yesterday confirmed the second death also involved a child. Pennsylvania reported the deaths to the CDC through the standard notifiable-disease process and classified them as measles-associated, which is a term used when lab or epidemiologic evidence of measles is present but not named as the immediate cause of death. The CDC’s weekly measles update, which is posted every Friday, did not appear. It was finally posted on Sunday, where the two deaths were excluded from the report with an asterisk noting that the relative contribution of measles to the deaths was unclear.

The New York Times reported that Dr. Erica Schwartz, confirmed as CDC director this month, ordered that note be added and directed agency officials to challenge the state’s report. Reuters reported today that HHS Secretary Robert F. Kennedy Jr. asked Schwartz to remove the deaths and that she complied, even though CDC staff had already accepted the state’s finding.

Death investigations are not within the purview of the CDC, so they rely on local health departments to do those investigations accurately and report their findings—this is how the national disease surveillance system has worked for many, many years. Dr. Anne Zink, Alaska’s former chief medical officer, said she could not recall the CDC ever publicly questioning a state’s cause-of-death determination. The concern extends beyond Pennsylvania, as many states are already holding back data due to concerns about how it will be used.

Here’s What Else We’re Watching

• The request for information on vaccine categories is still open. We walked through what’s at stake last week, including coverage and VFC eligibility. Submit through Regulations.gov by searching Docket No. HHS-OS-2026-0332. Comments are posted publicly, so don’t include anything you wouldn’t want online—they’re due September 20.

• The federal autism advisory committee (again) raised vaccines as a possible cause of autism at its August 27th meeting, despite existing evidence that there is no association. Ultimately, the committee’s strategic plan moved in a different direction, steering funding toward less well-understood areas like diet and folate-based therapies.

Almost every story in this piece is a similar argument in different clothes. They aren’t arguments about whether vaccines work, because evidence continues to support that as consistently as it ever has. It’s more an argument around who gets to say what’s true, who writes the recommendations, and who counts the deaths.

You can’t “correct” your way out of those in the same way you can correct a false claim. You may be looking for information in different places, but the societies and initiatives like the Vaccine Integrity Project are still doing the work, as are the states who are keeping count. And ultimately, your own clinician knows your history better than a federal document ever will.

What are you hearing from your own clinicians and school nurses this month? Any vaccine concerns? Don’t forget to share them with us in the comments, or email us at vaccines@unbiasedscience.com.

Stay Curious,

Unbiased Science

This piece is cross-posted with CIDRAP.

So, today we’re doing something different.

Yesterday I had the honor of sitting on a panel hosted by Montana Families for Vaccines, a grassroots network of Montanans advocating for fact-based immunization policy. The event was part of their annual celebration of Dr. Maurice Hilleman, the Montana farm kid who went on to develop more than 40 vaccines, including the combined MMR (no big deal!). His work has likely saved more lives than that of almost any other scientist in history.

My fellow panelists were the legendary Dr. Paul Offit, Dr. Demetre Daskalakis, and Kirsten Hilleman, Dr. Hilleman’s youngest daughter. Kirsten appears in the documentary, Hilleman: A Perilous Quest to Save the World’s Children, receiving the mumps vaccine her father developed from a swab he took from her sister Jeryl Lynn’s throat in the middle of the night. (The Jeryl Lynn strain is still the mumps component in the MMR your kids get today. Isn’t that incredible?)

The timing of the panel was kind of eerie. We spent an hour celebrating the man who did more than anyone to make measles a memory in this country, in the same week that Pennsylvania confirmed two unvaccinated Lancaster County residents had died of it. They were the state’s first measles deaths in 35 years and the first anywhere in the country this year.

It has since become a political fight, which we posted about on our social media pages. Pennsylvania used the term “measles-associated,” which it applies when there’s laboratory or epidemiologic evidence of measles even if the coroner hasn’t assessed measles as the immediate cause, and that word has been seized on to argue nobody actually died of measles. One of the two was a newborn. The Lancaster County coroner says the baby’s primary cause of death was a laceration (a tear) of the spleen. A postmortem test on the baby’s lung tissue found evidence of a measles infection acquired before birth, a finding NBC News independently confirmed with the coroner. The autopsy did not find the spleen to be enlarged, and investigators are still determining what caused the laceration. Pennsylvania continues to classify the death as measles-associated. Almost nothing has been released publicly about the second death.

The state’s health department told CIDRAP that the spleen is full of immune cells, which makes it a place where the measles virus can survive and multiply, causing inflammation and tissue damage. The department did not specify whether that requires visible enlargement. Dr. Offit told the Inquirer that the coroner’s account doesn’t add much, since measles can cause an enlarged spleen, birth can rupture it, and once a spleen has ruptured it’s difficult to tell whether it had been enlarged beforehand. Secretary Kennedy went much further, suggesting on X that the deaths may have been fabricated altogether by one of the governor’s staffers.

The fight has spilled over into social media, where some people are telling us we are overreacting about the deaths. That is a sentiment I simply cannot grasp.

The “died with it, not from it” framing often gets treated as a gotcha. Let’s unpack what those phrases really mean. Infections often kill through the complications they cause rather than by appearing alone on a death certificate. So a death by complication is still a death from the disease, even when it’s officially classified as “associated with” the disease. For example, measles most commonly kills through pneumonia or encephalitis, where the infection sets off the cascade that ends in death. But that same principle can’t be stretched to settle every case automatically, either. A spleen injury during birth is very rare. While the measles virus can inflame and damage the spleen, the mechanism by which that might lead to a laceration isn’t well established in the medical literature. The role that measles played in these two deaths is a question the clinical and forensic evidence will have to answer, and that evidence isn’t all public yet. One thing isn’t in dispute. This baby had measles, acquired before birth, and no newborn is eligible for the MMR, which isn’t routinely given until 12 months (but can be administered as young as 6 months in an outbreak). Whatever the coroner concludes about the spleen, an infant was infected because measles is circulating in a community that no longer has enough protection to stop it.

Please remember this: what a coroner determines, what a health department classifies, and what a politician says about both are three different things. Most of the confusion right now comes from treating them as one. No matter what, it is alarming that we are seeing this number of cases of a disease that was eliminated in the United States in 2000. Plus, as Dr. Offit points out, the fact that these numbers are so high during the summer (when measles is typically a winter disease) does not bode well.

Back to the panel… The first question of the day was directed to me. I was asked to provide a summary of where things stand with vaccines today (no biggie, ha!). I walked through the high-level way my brain organizes the vaccine landscape. We often share deep dives on specific issues as they unfold, so I thought it might be helpful to step back and share the 30,000-foot view with you.

Let’s discuss…

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Taking multiple hits

I sort all of this into three buckets. What’s happening federally, what’s happening in the states, and what’s happening in the broader discourse. Within each bucket, there are many separate ways vaccines can be affected, which is what makes this feel less like one fight and more like many at once.

Picture arrows hitting different parts of the body simultaneously. One is aimed at the schedule, meaning which vaccines are recommended and when. Another at access, meaning what insurance covers and whether the system actively offers you a vaccine, which can change without the schedule changing at all. Another at what officially counts as a vaccine injury, meaning which conditions get presumed to be caused by a vaccine without evidence that they are (this impacts how risky it becomes for manufacturers to produce vaccines). Another at state exemption laws. Another at who sits on the committees that write the recommendations in the first place. Another at the data systems that tell us how many kids are actually protected. That’s a lot of arrows.

Federal

The most important thing to know about the federal picture is that most of what’s been attempted is currently on hold. A brief recap…

In June 2025, Secretary Kennedy removed all 17 members of the committee that advises CDC on vaccines and replaced them with his own appointees. In January, HHS narrowed the childhood vaccine schedule to protect against 11 diseases instead of 17, with no public comment period, no advisory review, and no new safety data. In March, a federal judge in Boston blocked the bulk of it in a case brought by the American Academy of Pediatrics and six other medical and public health groups, finding the administration likely broke the law both in how it rewrote the schedule and in how it rebuilt the committee. The schedule changes, most of Kennedy’s appointments, and the votes the reconstituted committee took are all frozen. HHS has appealed.

On August 10, the President signed an executive order pursuing the same direction from a different angle. It endorses the shorter list, calls for splitting the MMR into three separate shots, directs that vaccines be given at separate visits, and points the Justice Department at state exemption laws.

The MMR provision lands at a particularly bad moment given where measles is right now. No standalone measles, mumps, or rubella shots are licensed in the United States, and both Merck and GSK have said they aren’t interested in making them. There’s no evidence that separating the shot helps anyone, and doing it would mean more needles, more visits, and more chances for a child to miss a dose.

There’s also a push to add autism to the federal vaccine injury table. If a listed injury occurs after a listed vaccine within a specified time window, the program generally presumes the vaccine caused it rather than requiring the claimant to prove causation. Adding autism would create a legal presumption of causation for something decades of research say vaccines don’t cause. With roughly 120,000 children diagnosed with autism in the U.S. each year, even a fraction becoming eligible for presumptive claims could create enormous financial exposure for the program and vaccine manufacturers, potentially making some vaccines too risky to manufacture.

How vaccines get categorized, and why that affects access

We haven’t discussed this yet, so we’ll take a bit longer to explain. On August 21, HHS announced a public comment period on a request for information about how vaccine recommendations get labeled.

Federal recommendations currently fall into three categories. Routine means nearly everyone in an age group should get the vaccine; MMR for children is an example. Risk-based is narrower, for people with a particular health condition, job, exposure, or travel plan; yellow fever vaccination before travel to certain countries is one example. Shared clinical decision-making covers cases where a vaccine may make sense for some people in a group but not everyone; HPV vaccination for adults ages 27 to 45 is an example.

The request asks whether those three categories are enough, floating labels like recommended “with qualification” and recommended “but not during infancy” without defining them or naming a single vaccine that might move.

It changes nothing by itself, but the category a vaccine falls into has big implications. It’s tied to coverage protections, including requirements that many health plans cover recommended vaccines without cost sharing, and some legal experts have warned that new categories could open a path for insurers to drop that and could affect Vaccines for Children eligibility. It also shapes what pops up automatically in a clinic’s system and whether the pediatrician or family physician raises a vaccine as a given or as an option. HHS wouldn’t need to take a vaccine off the schedule to sharply cut how many kids get it. Changing the category would do that.

Some of what the request raises is legitimate. Recommendations should be easier to understand, and agencies should be clearer about uncertainty. The concern is what happens if things other than evidence start deciding what counts as medically recommended.

If you want to comment, our friends at Voices for Vaccines have organized a webinar to help draft one! It will take place on Tuesday, September 2nd at noon EST. Register here! If you are unable to attend, here are some ideas to get you started:

1. Timing should follow risk. Babies are vaccinated early because they’re the ones most likely to be hospitalized or die from these diseases, so a category like “recommended, but not during infancy” makes being a baby the reason to wait.

2. All strong evidence should count, not just randomized trials. Once we know a vaccine prevents a serious disease, leaving a group unprotected for comparison is unethical, which is why we also rely on health databases, real-world studies, and safety monitoring.

3. Shared decision-making is for real uncertainty. If a vaccine clearly helps nearly everyone in a group, it should stay routine.

4. Vaccines given together should stay together when the studies support it. Separating them means more appointments, more needles, and longer stretches when kids aren’t protected.

5. Science questions and policy questions are different questions. Whether a vaccine prevents disease is about evidence. How recommendations interact with consent and exemptions is for policymakers.

Submit through Regulations.gov by searching Docket No. HHS-OS-2026-0332. Comments are posted publicly, so don’t include anything you wouldn’t want online. Comments are due by September 20, 2026.

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States

With the federal changes stuck in court, a lot of the action has moved to statehouses and state health departments, where the federal injunction doesn’t apply. It’s moving hard in both directions at once. (We cover a lot of this in our biweekly series with CIDRAP. Stay tuned for that next week.)

Florida is the clearest example on one side. On August 20, the state surgeon general approved a proposed rule that would:

• Remove hepatitis B, chickenpox, Hib, and pneumococcal vaccines from school and childcare entry requirements.

• Change the religious exemption form to accept any moral or ethical objection.

• Let parents and college students opt out of the state immunization registry.

The rule is open for comment through September 14 and isn’t final.

That third one is the arrow aimed at the data. A registry is one of the main ways a state knows who’s been vaccinated. Schools use it to verify status, it’s where coverage numbers come from, and it’s the first thing a health department pulls up when measles shows up at an elementary school and someone has to figure out fast which kids are vulnerable. Let enough families opt out and you’re managing an outbreak with a much less complete picture of who’s protected.

Going the other way, California has said it will keep its school requirements regardless of the executive order, and it’s far from alone. A majority of states have said they’ll look somewhere other than CDC for at least some childhood vaccine recommendations, many to the American Academy of Pediatrics or their own expert panels, specifically to protect their policies from federal changes.

So, the schedule a family actually encounters is becoming a function of their zip code.

New CDC data for the 2025-26 school year show exemptions rising in 41 states and D.C., the biggest annual jump in more than a decade. Coverage fell for every reported vaccine, leaving roughly 280,000 kindergartners without a documented MMR series. In Lancaster County, where the two deaths happened, MMR coverage is 87.6%, well below the roughly 95% generally needed to keep measles from spreading.

Parting thoughts

And then there’s the public discourse around all of this. Vaccine myths and misconceptions are everywhere, increasingly amplified by prominent health officials alongside the usual social media chatter. As policy changes play out publicly and often confusingly, that constant noise makes it harder to know what to trust, and steadily erodes trust itself. Perhaps that is the point?

The moderator of the panel closed by asking each of us for a final thought.

Dr. Daskalakis reminded us to vote with our feet. Where we get our care, where we spend our money, which institutions we support, who we elect. Public health isn’t only something that happens to us from Washington. It’s also the accumulated weight of a lot of individual choices, and those choices are still ours. He also said we need to build bridges, not dams. Most of the people who are uncertain about vaccines aren’t the loud accounts online. They’re quieter, and reaching them means being willing to cross over and talk with them, or at least meet them partway.

Dr. Offit went to Galileo. After the Church forced him to recant the idea that the Earth moves around the sun, Galileo is said to have muttered “eppur si muove.” And yet it moves. The science doesn’t care what we do to it or say about it. People can spread lies, agencies can be reorganized, labels can be rewritten. Measles will still be one of the most contagious viruses on earth. The MMR will still work. The Earth will still go around the sun.

Here’s where I landed. Conditions right now are close to ideal for distrust of vaccines to take hold. There’s real frustration out there, people are tired, and the pandemic left behind divisions that never closed. That frustration is legitimate, and it’s also easy to harvest.

But we're not without options while all of this plays out. Policy matters enormously, which is why we cover it every other week and why we're telling you how to comment on that federal docket. It also isn't the only place any of us has leverage. Some of the most consequential conversations about vaccines happen in kitchens and group chats and school pickup lines, with people who already trust us. That trust doesn't scale, which is exactly why it works.

Those conversations can be uncomfortable. Please have them anyway.

Stay Curious,

Unbiased Science

Do you all remember that iconic Staples back-to-school commercial where the dad was gleefully dancing around the store set to “it’s the most wonderful time of the year” while the kids drag their feet and scowl?

It was the opposite vibe in my household. My kids were so excited to see their friends and their teachers and get back into a routine. I, on the other hand, found it quite bittersweet. Their excitement made me excited, but if I squinted my eyes a bit, I swear I could picture them getting dressed for high school graduation – and then suddenly someone started chopping onions! It is all happening so quickly. The school mindset made me think about some kid-related safety topics and things we’re doing to keep our little ones happy and healthy. This is certainly not an exhaustive list, and not all of it will be relevant to all ages, but I hope it is helpful.

So, what’s on my mind heading into this school year? Let’s discuss…

1. Respiratory season

I write a lot about vaccines (and have a lot more in the works), so I’ll be brief on this topic. We are entering respiratory illness season, and our entire family will be getting this season’s updated flu and COVID-19 vaccines, just as we do every year. We make sure to get our flu shots before Halloween (you can remember this with “flu before boo”), which usually lands in late September or early October for us. We typically get our COVID-19 shots at the same time as our flu shots, but we are monitoring local levels and if they climb fast, we may get them sooner.

We also wear high-quality masks in pediatric (and all medical) waiting rooms, especially during peaks, since that waiting room is a small enclosed space full of sick children (aka a petri dish). We open windows when the weather allows, at home and in the car. If cases spike locally, we avoid crowded indoor spaces whenever possible. It is all helpful at reducing risk.

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2. Helmets, on anything with wheels

Helmets are non-negotiable in our household (strictly enforced by my ER doc hubby). The best evidence we have is a meta-analysis of 179 effect estimates from 55 studies, which found helmets reduce head injury by 48%, serious head injury by 60%, and traumatic brain injury by 53%, with the same benefit for kids as for adults.

To help with compliance, we had both kids pick out their own helmets and covered them in stickers, so it’s their helmet rather than something we’re making them wear. (Fit matters more than decoration, so it should sit level and low on the forehead, about two finger-widths above the eyebrows, with the side straps forming a V just under the ears.)

On a related note… let’s talk e-bikes, because we see people zooming all over town! A new UC San Diego analysis of statewide California collision data found e-bike crashes rose from 2 in 2018 to 1,506 in 2024, with more moderate-to-severe injuries than traditional bikes. And among people hurt in each type of crash, kids 14 and under made up a bigger share of e-bike injuries (15.6%) than traditional bike injuries (10.2%). The researchers noted low helmet use among injured riders, and that the higher speeds generate crash forces closer to a motorcycle than a bicycle. We’re not doing e-bikes at these ages, though I understand the families who do, especially when it’s how a teenager gets to school.

3. Water, in a few different ways

Gut-wrenching news broke this week that an eight-year-old in Louisiana died after swimming in a lake. That case involved Naegleria fowleri, an amoeba that lives in warm fresh water and causes infection when water gets forced up the nose. It’s horrifying, but still extraordinarily rare, with roughly 180 confirmed US cases between 1937 and 2025.

Warm water in late summer holds all sorts of organisms (bacteria and amoebas among them), and different water carries different risks. Brackish water, meaning the part-fresh, part-salt mix you get in estuaries and marshes and anywhere a river meets the ocean, is where Vibrio lives, bacteria that can cause severe infection when they get into a break in the skin. We ran into this in June on a quick trip to Acadia. The kids wanted to wade into a warm, shallow brackish stretch, and doctor dad took one look and said nope.

Louisiana has reported nine cases and five deaths this year against a 10-year average of about seven cases and one death, all from wounds exposed to seawater and all in people with underlying health conditions. Fresh water brings its own issues, including cyanobacteria blooms that can make kids and dogs very sick.

Practically speaking, you can check your state or county advisory page before you take a dip in the lake, and keep kids out of the water if they have any open wounds. The tricky part is that you often can’t see skin breaks (documented entry points include a scrape from a dock, a broken blister from new water shoes, an unhealed tattoo, and even freshly shaved legs). Wash any cut that happens in the water with soap and clean water. (And it’s a good idea to take a shower when you get home!) If a wound that’s been in brackish or salt water turns red, swollen, warm, or painful, get it looked at quickly and tell the clinician about the water exposure, because that detail changes what they’re thinking about. If kids are jumping in or dunking each other in warm, shallow, slow-moving fresh water in late summer, nose clips or hand pinching the nose shut is a good idea, and it helps to stay off the bottom where sediment gets stirred up.

If we’re talking about swimming, we also need to talk about swim safety and drowning prevention. Drowning is the leading cause of death for children ages 1 to 4, and it doesn’t look anything like it does on screen. There’s typically no splashing, no waving, and no yelling, because a child who is drowning usually can’t call out at all. What it actually looks like is a body upright in the water and facing shore, head tilted back with the mouth right at water level, and arms doing something like climbing an invisible ladder, and it can take as little as 30 seconds.

A staggering 88% of child drownings happen with at least one adult present, and half happen within 25 yards of a parent. Both of my kids have taken lessons and swim well, but good swimmers still drown. We don’t leave the kids unattended in water despite them being strong swimmers.

The National Drowning Prevention Alliance frames prevention as five layers that work together: barriers and alarms, supervision, water competency, life jackets, and emergency preparation (meaning CPR and a phone within reach). They’re layered because any one of them can fail. Ours look like a designated adult whose only job in that moment is watching the water with the phone down (they recommend rotating that role every 15 minutes), touch supervision for anyone who isn’t a strong swimmer, no swimming alone, and Coast Guard-approved life jackets whenever we’re out on a boat.

Drowning remains a major risk across all age groups, so supervision style should evolve with a child’s development rather than stopping entirely.

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4. Teeth

We snuck in dental appointments earlier this week before we had to compete with school schedules. (On the way out, I scheduled appointments for February and March 2027. Does everyone else just arbitrarily accept the date and time because the future date doesn’t seem “real” yet?) Everyone in our household gets cleanings every six months. Our son is excellent about brushing but considerably less excellent about flossing, which has led to some cavities. The dentist had a great suggestion at the end of the visit. He said that sternly telling kids to “floss every day” right away can feel overwhelming. Instead, he said work it into the routine once a week to start and then add on a day of flossing every week that passes. This makes it more approachable and doable.

Cavities are still the most common chronic disease of childhood and most of them are preventable. We stay on top of fluoride varnish at checkups, sealants on the molars where the grooves trap food, and the daily part, brushing twice with fluoride toothpaste (a rice-grain smear under age 3, a pea-sized amount after that) and flossing.

Given everything going on with community water fluoridation, one note: if your water supply has changed, or if you’re on a well, ask your dentist whether that changes anything for your kid in terms of varnish frequency or supplementation.

5. Fiber, greens, and getting the kids in the kitchen

Every meal in our house has fiber and something green in it. It’s an addition rather than a substitution and there’s no lecture attached. Most Americans (kids included) fall short on fiber (a whopping 90-95%), so it’s a good idea to work in more beans, whole grains, fruit with the skin left on, and vegetables in whatever form they’ll actually eat.

We do not do “good food” and “bad food” framing in our household. It comes down to overall dietary habits and making sure you get enough fiber and nutrients. There’s room for sweets and snacks, and in my experience making a food forbidden mostly makes it more appealing.

What’s helped most is having them in the kitchen. Kids who help shop, wash, chop, and cook are more willing to eat what comes out of it, and they’re picking up a skill they’ll need eventually anyway. Growing food does something similar, since a kid who watched a tomato go from green to red is more willing to eat it than one who found it in a plastic clamshell. Our outdoor season here is short, so we keep herbs going indoors through the winter (hot tip: basil, mint, and scallions are nearly impossible to kill).

There are a zillion other things I could have included, so this may well become a series. I’d love to hear the things you’re thinking or wondering about in the comments.

This school year will be messy and it will bring its challenges, and we’ll get through it. It’s maybe good to remind ourselves that our kids aren’t the only ones doing this for the first time. I have never been the mom of a third grader and a fourth grader before. Every phase they enter is one I am entering right alongside them, and we are all just doing our very best.

Stay Curious,

Unbiased Science

On the list this week, a preprint arguing that a newly approved flu vaccine should be pulled from the market, a petition asking the FDA to take Infants' Tylenol off pharmacy shelves, polling showing that most Americans are not actually anti-vaccine, and food safety news that will not quit. Let’s discuss…

Another reanalysis, another vaccine on trial

On August 5, the FDA approved Moderna’s mRNA flu vaccine, mFLUSIVA, for adults 50 and older, and we are very excited about it.

Two weeks later, a preprint posted to Zenodo (an open file repository where anyone can upload a document and receive a citation-style DOI, with no peer review) reanalyzed the agency’s own data and concluded that the approval should be reversed and distribution halted. Does it have any teeth?

Well, the numbers in it are accurate. They come from FDA’s briefing document and the trial published in the New England Journal of Medicine. However, what happened to those numbers afterward is another matter. They’ve been arranged to make a vaccine that works look like one that doesn’t, in at least three ways.

1. Four hospitalizations are doing all the work. A graphic making the rounds says 5,017 vaccinations were needed to prevent a single hospitalization, which makes it sound like the shot barely works. What it actually means is that 5,017 people would need the mRNA shot instead of a standard flu shot to prevent one additional hospitalization, since everyone in the trial got a flu vaccine and nobody was left unvaccinated for comparison.

That figure also rests on remarkably few events (i.e., hospitalizations). Roughly 20,000 people received each shot. Eight people in the standard-shot group were hospitalized; only four in the mRNA group were. That’s a difference of four hospitalizations across 20,000 people, which is where “one per 5,000” comes from. But when the whole calculation hangs on a handful of cases, one more or one fewer can change the answer by a lot. If five people had been hospitalized in the mRNA group instead of four, the figure would have landed closer to roughly one per 6,700 instead. This is why FDA’s own convention, stated in a footnote in the document being reanalyzed, is to not calculate an estimate at all when fewer than 20 events have occurred. The result is too unstable to interpret.

Zoom out from hospitalizations alone and a clearer pattern appears. Every one of these figures compares the mRNA shot against a standard flu shot, so they measure how much illness it prevented on top of what a regular flu shot already prevented. Across all confirmed flu cases, including mild ones nobody sought care for, it cut cases by 26.6% beyond the standard shot. Among cases where someone sought medical care, that rose to 33.7%. Among cases serious enough to need urgent care, an ER, or a hospital bed, it reached 47.9%. The sicker people got, the more the vaccine appeared to help, which is the reverse of what the graphic implies.

2. The death claim comes from a different, bigger dataset, and it works by ignoring the total. The hospitalization numbers above come from the single pivotal trial. For deaths, the preprint switches to FDA’s Integrated Safety Summary, which pools all four Phase 3 studies of the vaccine, including earlier ones that tested different doses and formulations. Across that pooled group of nearly 72,000 participants, 102 died in the mRNA groups and 97 in the comparison groups, essentially even.

That comparison isn’t what the graphic shows. It isolates a narrower category, deaths where no cause was ever recorded, 23 in the mRNA group versus nine in the comparison group, and treats the gap as deaths the vaccine caused. Subtract those from the full totals and deaths with a recorded cause were actually fewer in the mRNA group. Cardiac deaths were fewer too (24 versus 30), which stands out because the paper leans hard on cardiac risk later on. The unexplained deaths also occurred a median of about four months after a single injection, later on average than comparable deaths in the other group, which argues against the kind of acute vaccine effect the graphic implies. There’s also a mismatch buried in the comparison itself, since the hospitalization figure comes from a trial against a standard-dose flu shot while the death figure comes from a pooled database whose comparison group mixes standard-dose and high-dose vaccines. The preprint concedes this in its text, then puts the combined number in the graphic anyway. FDA flagged the imbalance, said it can’t be fully resolved because no autopsies were performed, and is requiring active surveillance going forward.

3. A bad two days is not the same as a hospitalization. The centerpiece is a ratio, 233 severe reactions for every hospitalization prevented. A “severe” reaction here means one that kept someone from their normal daily activities for a period of time, a step below the most serious tier, which would have required an ER visit or hospital stay; no reactions in the pivotal trial reached that level. Across all reactions of any severity, the median duration was about two days. Weight a two-day reaction and a hospital admission equally and almost any effective vaccine looks catastrophic, because side effects are common and the hospitalizations being prevented are rare.

To be fair, the mRNA flu vaccine does cause more short-term side effects (aka reactogenicity) than a standard flu shot. Injection site pain, fatigue, headache, and muscle aches were all substantially more common, and both FDA and NEJM acknowledge this. There are real evidentiary limitations, too. Efficacy data cover a single flu season, and the approval for adults 65 and older rests on antibody responses rather than a head-to-head trial showing it prevents more flu than the high-dose vaccine most people that age would otherwise receive. That trial is required as a condition of approval and begins at the end of this month.

This isn’t the first time we’ve been through something from this group. The reanalysis comes from Nicolas Hulscher and Peter McCullough of the McCullough Foundation, with John Catanzaro of Neo7Bioscience, and the approach doesn’t vary much: real data, run through analysis that shrinks the benefit and inflates the harm. The paper declares no conflicts of interest. Two weeks before it posted, Neo7Bioscience and the McCullough Foundation announced a formal research collaboration marketing personalized peptides for mRNA vaccine injury. The studies the preprint cites to argue the vaccine platform is dangerous are the same ones the companies list as the scientific basis for those peptides, a direct financial stake in establishing the harm this paper argues for. The preprint’s fifth recommendation calls for developing interventions for people “already injured.”

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The petition to pull Infants’ Tylenol

Children’s Health Defense filed a citizen petition earlier this month asking the FDA to pull over-the-counter Infants’ Tylenol (acetaminophen) from the market and to add boxed autism warnings to acetaminophen products for children under six. A citizen petition is a public request form that anyone can file. It isn’t a recall, it isn’t a finding, and it isn’t the FDA co-signing it. The agency has 180 days to respond, and a response is frequently a denial.

But we’re concerned this is even being asked. Acetaminophen is the only over-the-counter fever and pain medicine routinely recommended for babies under six months, since ibuprofen isn’t recommended that young. The infant formulation also exists so dosing can be precise, with a syringe marked for small weights. Take it away and people improvise with adult tablets and kitchen spoons, which is how acetaminophen actually does hurt children. Overdose causes liver injury, and acetaminophen is already a leading cause of acute liver failure in this country.

The evidence doesn’t support the petition either. The largest and best-designed study on this question followed 2.4 million children in Sweden and compared siblings within the same families, which strips out the genetic and environmental factors that muddy every other analysis. It found no association. That study looked at use during pregnancy; a separate analysis of nearly 74,000 children across six European countries specifically examined acetaminophen given to babies in their first 18 months and found no link to autism or ADHD.

There’s also a court case in the background, which is part of why the petition landed when it did. In July, the Second Circuit revived more than 500 lawsuits alleging that prenatal Tylenol use causes autism and ADHD, finding that a district judge had improperly excluded testimony from three of the plaintiffs’ expert witnesses. Writing for the panel, Judge Guido Calabresi said explicitly that the court was not deciding whether acetaminophen causes autism or ADHD. The question was whether those experts applied accepted methods well enough that a jury should weigh their testimony. Judges screening expert evidence are supposed to filter out junk science, not pick a winner in a dispute scientists are still having. Expect that distinction to disappear when people share the headline.

Most Americans aren’t anti-vaccine

I was honored to be interviewed for a CNBC piece that ran yesterday. The framing comes from a KFF poll that put four common vaccine myths to a national sample, and the results are more interesting than the headline suggests.

Almost nobody is convinced the myths are true. Only 4% said the MMR-autism claim was definitely true, and 3% said the measles vaccine is more dangerous than measles itself (that’s good news). The poll also highlights, however, how few people are sure the claims are false. Only 33% called the MMR-autism claim definitely false, which means two out of three American adults aren’t confident that one is settled. The same pattern shows up on all four myths. Most people lean toward the truth, but few are certain of it.

That uncertain majority is often called the “movable middle.” They aren’t outright opposed to vaccines. They’re navigating conflicting messages from sources that all sound authoritative, and they’re trying to figure out who to trust.

This matters a lot right now. The CDC added 211 measles cases this week, bringing the year to 2,777, which is more than double last week’s increase and the most since 1991. Pennsylvania and Ohio are driving it, and 94% of patients are unvaccinated or of unknown vaccination status. Two out of three adults not being sure the MMR-autism claim is false, and measles accelerating, are the same story told two ways.

KFF also asked what keeps people in the-in-between, and the answer isn’t ideology. Adults without a doctor or clinician they trust were roughly twice as likely to believe the COVID vaccine death claim. People who rely on social media for health information were more than twice as likely to believe MMR causes autism. It largely comes down to not having access to reliable information delivered by someone they trust.

In case you missed it, six major scientific bodies also released a joint statement on childhood vaccination this week, reaffirming what decades of research across more than 23 million children show about MMR and autism.

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Food recalls galore

If you’ve been avoiding salad, you can stop. Health officials have confirmed that the recalled Taylor Farms iceberg lettuce behind this summer’s cyclosporiasis outbreak is off the market, new case reports are tapering, and Michigan, one of the hardest-hit states, lifted its advisory against bagged salad mixes earlier this month. (I have been stuffing my face with summer salads adorned with ripe peaches and goat cheese before the fall pumpkin takeover.) Counts are still climbing, but that reflects a reporting lag of up to six weeks rather than new infections. The outbreak has now reached 10,930 confirmed cases across 17 states, with 454 hospitalizations and two deaths.

It hasn’t been alone. FDA is investigating Salmonella in jalapeños from Sinaloa with 431 cases across 32 states. Federal officials are also investigating an outbreak of both E. coli and Salmonella tied to alfalfa sprouts, 55 sickened across 15 states, with FDA urging people to avoid sprouts sold under the Calco or Everything Sprouts brands. Finding multiple strains of E. coli and Salmonella in the same foodborne outbreak is unusual. On top of that, the FDA reclassified a recall of roughly 19 million eggs to its highest-risk category. The New Yorker’s daily cartoon on Friday was the food pyramid with every tier stamped RECALLED, which captures the sentiments of many people in our DMs.

USA Today is keeping a running list, and most items on it aren’t outbreaks. Glass in frozen fruit bars, undeclared milk in vegan cheese puffs, imported beef that skipped inspection. Those are recalls for very different reasons, which is a different story from a pathogen spreading through the food supply.

So, are we actually having more outbreaks, or are we just better at finding the ones we always had? There’s a lot of discussion about this right now, including over how the recall numbers themselves are being counted and compared. Faster genetic sequencing can turn what used to look like scattered unrelated illness into a recognized multistate outbreak, which would mean detection improved rather than food getting more dangerous. At the same time, NPR reported this week that state and local food safety programs run largely on FDA and CDC grants, and CDC’s grants were cut roughly 40% last year. Kentucky’s food safety staff is down 30 to 50%. About half the positions on West Virginia’s food safety org chart are vacant, and the state lowered its education requirements for the job in March because it couldn’t fill them.

We’re digging into this, as are several colleagues, so… more soon!

Stay Curious,

Unbiased Science

Let’s discuss…

COVID is on the uptick

CDC’s modeling estimates that COVID infections are growing or likely growing in all 50 states as of August 12, with no state showing a decline in infections. That might sound scary (and we absolutely need to be cautious), but let’s give a little context.

This figure tells us about direction only, not how much disease is out there. On that, the picture is calmer. CDC’s weekly respiratory summary has COVID activity low in many regions and increasing in the West and South, with emergency department visits very low. About 4% of tests came back positive last week compared with over 9% at this time last year, and CDC’s wastewater dashboard had national activity in the “very low” category for the week ending August 8. Stanford’s WastewaterSCAN network shows a sharper rise, with concentrations up about 106% in August over July. The two networks aren’t in perfect agreement, though both point upward from a low starting point.

Hawaii and Mississippi are the only two states in the moderate wastewater category. If you’re in New England (hi, neighbors!), you may not be seeing much of this yet, because summer waves have tended to start in the South and move north later in the year.

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Why does COVID surge in the summer?

Most of us learned that respiratory viruses are a winter thing, and flu and RSV do behave that way. COVID settled into a different rhythm. One analysis of U.S. incidence found three recurring annual rises, a main winter peak plus smaller ones in spring and mid-to-late summer. Why that happens is still an open question, and anyone telling you COVID’s seasonality is worked out is ahead of the evidence. What we have are some reasonable hypotheses:

1. Immunity timing. Most people who got vaccinated did it in the fall, and most people who got infected did it during the winter wave. By August, both are six to eight months back. A recent infection does buy you a few months where you’re less likely to catch it again, and for most people that window has closed by late summer, leaving more of us susceptible at the same time.

2. Climate and where we spend our time. In the hottest parts of the country, summer pushes people indoors into air conditioning just like winter pushes people indoors for the heat in colder states. Researchers have described COVID transmission oscillating between southern states in summer and northern states in winter, which fits the pattern we’re seeing now. CDC’s own summer scenario modeling anticipated increases in the South and West, the regions that didn’t see much activity last winter.

3. Travel and mixing. Peak travel season, weddings, camps, and family reunions all stack up in the same few weeks, and now schools are reopening too.

4. Variant turnover. SARS-CoV-2 keeps generating variants that partially evade existing antibodies. The most common lineage in sequenced specimens right now is XFG.1.1, a recombinant in the omicron family. BA.3.2 (nicknamed Cicada, so the word can now ruin your summer in two entirely separate ways) is also circulating here, and while it carries more than 70 mutations, several of which may help it evade immunity, it hasn’t become dominant.

5. A higher year-round baseline. Flu drops to very low levels between waves, so there’s little virus left to work with even when conditions are right for spread. COVID keeps circulating substantially all year, so there’s already more virus around when immunity wanes, behavior shifts, or a fitter variant shows up. The four factors above simply have more fuel to work with.

A few questions we keep getting

» Do at-home tests still work on the newer variants?

Yes. The test sitting in your medicine cabinet still works. Rapid tests look for a different part of the virus than the part that keeps changing. Most of the mutation happens in the spike protein, which is what your antibodies are trained to recognize. Rapid antigen tests target the nucleocapsid protein, which has stayed relatively stable over time. That’s why a variant can dodge your antibodies and still light up your test strip.

Rapid tests can still fall short when it comes to the timing of the test and your viral load. Studies have shown that these tests generally pick up roughly 80-90% of infections in people with symptoms, but drop to roughly half or less in people without symptoms. A positive result is highly reliable either way and false positives are rare. A negative result is a different story, though. In someone with symptoms, it’s still a meaningful “maybe”, and in someone without symptoms, it’s an even bigger “maybe”, which is why the FDA recommends re-testing after 48 hours have passed.

And before you toss the box in your junk drawer, check the FDA’s extended expiration list, because a lot of kits are still good past their printed date. The expiration date isn’t just a suggestion though, and false negatives become much more common.

» What symptoms should I watch for, and are they different with this variant?

The list looks a lot like it has for the past few years, since these are all Omicron descendants. Cough, sore throat, congestion, fatigue, fever, chills, shortness of breath, headache, and GI symptoms like nausea and diarrhea are all on the CDC’s list, typically showing up two to fourteen days after exposure.

The “this variant has its own signature symptom” claim comes around every wave (you may remember “razor blade throat” attached to Nimbus last year). It usually starts with a handful of anecdotes or a small survey, gets amplified, and then doesn’t hold up when anyone looks at systematic data. How your illness feels depends on your age, your vaccination and infection history, and the variant itself. So, you often can’t tell COVID from flu, RSV, or strep by symptoms alone, which is the whole argument for testing rather than guessing.

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» I tested positive. Now what?

Most people recover at home, and by now the drill is familiar: stay home until your symptoms are improving and you’ve been fever-free for 24 hours without medication, then be careful around anyone vulnerable for a few more days. CDC’s guidance here is the same across COVID, flu, and RSV.

The antiviral question is where things have shifted. Paxlovid is a pill you start within five days of your first symptoms, and it built its reputation on a 2021 trial that found a large drop in hospitalizations and deaths. Two new trials published in April tested it in today’s world, in more than 4,200 higher-risk adults who were almost all vaccinated, and found no reduction in hospitalization or death.

The numbers underneath explain most of that. In the 2021 trial, roughly 1 in 15 people in the comparison group were hospitalized or died. In the new trials, fewer than 1 in 100 were. Vaccination and prior infection have pulled the risk of severe COVID down so far that there’s much less severe illness left for any drug to prevent, and when events are that rare, a trial can’t rule out a smaller benefit either.

So, the practical advice hasn’t changed much. If you’re at higher risk, call your clinician in the first day or two rather than waiting to see how bad things get. Wait too long and the option is gone. Go in with the right expectation, though. For many higher-risk vaccinated adults, the clearest benefit may now be a shorter illness rather than a prevented hospitalization, and observational data still point toward benefit in the oldest and highest-risk patients. It also has side effects and interacts with a lot of common medications, so talk it through with your clinician before you start it.

» What else actually helps, besides vaccines?

A well-fitted N95 or KN95 works well to reduce exposure in crowded indoor spaces, and it’s a reasonable thing to wear on a flight, in a packed waiting room, or on a grocery run during a local spike. Ventilation matters too, since this is an airborne virus and more fresh air means a lower concentration of virus in the room. Opening a window, running a HEPA filter in the room where people gather, or moving a get-together outside all lower the dose you’re exposed to.

None of this is all or nothing. Every layer you add lowers the amount of virus you’re exposed to, and the more you stack, the better protected you are. For people who are immunocompromised, or are caring for someone who is, these may need to be a regular part of life, not just spike-season measures.

» How well does the COVID vaccine actually work?

Better than the “I got vaccinated and still got COVID” stories suggest. CDC’s surveillance system put last season’s vaccines (combined across manufacturers) at 58% effective against hospitalization and 49% against emergency department and urgent care visits, measured through six months after vaccination and strongest in the first couple of months. A separate analysis of the Pfizer version found about 57% effectiveness against emergency and urgent care visits four weeks out. For context, flu vaccine effectiveness usually lands somewhere in the 40% to 60% range in a decent year.

What the vaccine is not is a force field against catching the virus. Whatever protection it offers against infection itself is modest and fades within months, while the protection against ending up in the hospital holds up considerably longer. That’s the trade it’s built around. If you get vaccinated and still get COVID, the vaccine did not fail you.

» Can I get my flu shot at the same time?

Yes, and if the timing works out, do them together. CDC has concluded that co-administration is safe, and a study of more than three million adults found similar protection against hospitalization and emergency department visits whether the shots were given together or separately. You may feel a little more achy or tired for a day, which is a fair trade for one trip to the pharmacy instead of two. The single visit is also the version people actually complete, since two trips means two chances for life to get in the way.

» Should I get the updated COVID vaccine now, or wait?

The 2026-2027 formula targets XFG, which is a good match for what’s circulating. All three manufacturers showed it generating high antibody levels against the JN.1 family, though less against BA.3.2, which is part of why surveillance for that one matters. It isn’t available yet. FDA issued the strain guidance in May, and as of last week state health departments were still reporting that ordering hadn’t opened. Last year the updated shots were approved in late August and reached most pharmacy shelves through September, so late August into September is the reasonable expectation this year, though timelines can slip.

I can’t give medical advice, and the right answer depends on your age, your health, and your risk tolerance. Here’s what my family is doing. In a typical year I’d get my COVID shot later in the fall to line protection up with the winter peak, and we’d get flu vaccine at the same visit. Because we’re in a surge, I’m not waiting on the COVID shot this year, and I’ll get the updated formulation as soon as it hits my local pharmacy. My husband and kids will do the same. Flu is different. We’re waiting until late September or early October to get that vaccine, and will adjust earlier if it looks like a fast start to the season, because flu protection wanes and getting it too early risks it fading before flu season peaks.

If you’re at high risk and in a place getting hit hard right now, the current formulation may still be in stock nearby, and taking that versus waiting a few weeks for a better-matched shot is a real tradeoff to raise with your clinician.

» If protection wanes at six months like flu, shouldn’t I get two shots a year?

Your body builds two layers of defense after a shot, and they don’t fade at the same rate. Antibodies come first. They peak within a few weeks, then drop off over the following months, and they’re the layer that most affects whether you get sick at all. That decline is the six-month number people are citing, and it’s real.

The second layer is memory B cells and T cells. They stick around much longer, and they’re what keep an infection from turning severe. A systematic review found that all forms of immunity waned over six months, and that protection against severe disease was by far the most durable. Vaccine schedules are built around that second layer rather than around keeping antibodies at their peak year-round, which is why a second annual dose isn’t part of the schedule for most healthy adults under 65.

Two doses in a season is already the recommendation for adults 65 and older, generally spaced about six months apart, and people who are moderately or severely immunocompromised follow a separate schedule that may include additional doses. Since November 2025, CDC has framed COVID vaccination for everyone 6 months and up as individual-based decision-making rather than a universal recommendation, so “recommended” now means something closer to “have the conversation and decide” than it used to. The American Academy of Pediatrics (AAP) breaks from away from that framing for children. Its 2026 schedule recommends COVID vaccination universally for children 6-23 months, and on a risk-based schedule for ages 2-17. AAP also recommends it for any child 2-17 years whose parent wants the protection, even outside a high-risk group.

So yes, COVID is very much still a thing. It isn’t 2020, and the tools we have now are better than the ones we had then. But it’s circulating, it’s climbing, and a little attention right now costs almost nothing.

Stay Curious,

Unbiased Science

Stray grays, crow’s feet, smile lines that don’t fully go away anymore. All of it is a badge of honor. Thinking about my life in decades instead of years highlights how much has changed.

My first decade was the formative one. The earliest pieces are fragments, the kindergarten mat at rest time. Putting on my mother’s heels, following her around like a shadow, watching my father shave and patch the nicks with little flags of toilet paper, knowing the exact comfort of my grandparents’ laps, making friends outside of family. I still have distinct memories of the smell of my apartment building hallways, the pattern of my elementary school floor tiles, my teachers’ names and dispositions (the ones we liked and the ones we were a little scared of). The routines my family kept, tracing the same car route to the grocery store, walking the Coney Island boardwalk with my mom. The sights, the smells. All of it imprinted on me.

My second decade was coming into my own. The teenage years, the hormones, the big feelings. Figuring out my likes and dislikes and trying new things, good and bad. Running around the streets of Brooklyn with my friends and getting into trouble (well, light trouble, I was always a rule follower). Losing my grandfather when I was 11, my first experience with death. My first love and my first heartbreak. The stress of college applications, and then realizing almost immediately how good we’d had it in high school. My father teaching me to drive in the Floyd Bennett Field stadium. The thrill of driving around in my mom’s Volkswagen Beetle with my friends in the car and the music blasting, which was the most freedom I had ever felt (just thinking about my own kids doing this is giving me heart palpitations). Going off to college and watching my mom cry as the car pulled away, not fully understanding why.

My third decade was becoming a woman, finding my life’s passion, and exploring different career paths. Medicine, then law, then landing on public health. The beautiful stress of grad school. Making big mistakes and course correcting and figuring out my way. More love, more heartbreak. Losing my grandmother at 20, and with her, our lunch dates over borscht and pierogi. My first real job and my first real paycheck. Somehow finding the energy to be a full-time student while cobbling together tuition from ten different part-time jobs (where did I find that energy?). Train rides in and out of NYC day after day, writing papers on the LIRR with the stop announcements blaring overhead. Becoming Dr. Steier. Moving up the ladder, meeting my husband and figuring out that he was my person, adopting cats, moving cross-country to be closer to my parents, getting married under banyan trees with everyone we love in front of us.

My fourth decade was becoming a mother, which meant becoming an entirely new person with entirely different priorities. Falling madly in love with two little humans I worship, then watching them turn into actual people with distinct personalities. Feeling a kind of anxiety I didn’t know existed every time they got sick or got hurt. Watching my father get sicker, and then suffering the greatest loss of my life when his heart stopped in December 2019, and becoming a new person yet again. Living through a global pandemic. Finding science communication, which is now the work I care most about. Another cross-country move, and five dogs fostered and rescued along the way. Reinventing myself and my work. Weathering personal and professional losses I’ll be grappling with for years, including betrayal and bullying and a different kind of heartbreak. Surviving it, then thriving. Building a business, and alongside it trying to build something bigger, an argument that science communication is a discipline in its own right. Learning that lifelong friendships can begin in any decade, and that they feed your soul. Noticing creaking bones and muscles I didn’t know I had. Feeling very mixed about getting older, and grateful at the same time.

What the next decade brings, I don’t know. I’m told the 40s are the best decade, the one where we finally live for ourselves and come into our own, with most of the “what will I be when I grow up” worry behind us. This is supposedly where we thrive. I’ve learned a great deal and I am less certain of things than I was at 30, which I’ve come to think of as progress. There is plenty left to learn. I’m fairly certain there will be high highs and low lows. I’m excited anyway.

I’m celebrating in the best way I know how, which is surrounded by my people. My mom is in town (her birthday is tomorrow, two Leo lionesses a day apart). My childhood best friends are driving in from New York, and other friends have flown in from Argentina and Florida. We’ll hang out and barbecue and laugh and sing and enjoy each other’s company. I feel unbelievably lucky.

Writing about my life this way feels strange. So many things, big and small, fleeting moments locked into history, every second of every day contributing to who I am right now. It also carries a weight I wasn’t expecting, because setting it down in decades shows me how much of it is already behind me. The people, the places, the routines, the versions of myself, all of it receding, and time only ever moving in the one direction. My father is in these paragraphs and he is not here. I am old enough now to know he will not be the only one.

And writing this to you, on the platform I built brick by brick, is surreal. It’s the greatest gift I could have asked for. Thank you for being here, for following along with Unbiased Science (my third child), for letting me live so much of my life through this work. Here’s hoping the next ten years shift the work itself, so that we spend less time rebuilding trust in science and more time talking about the things that made me fall in love with it in the first place. The advances that change lives. The wins we get to celebrate. The unglamorous work of helping people live longer and feel better.

Onwards to decade five.

Stay Curious,

Unbiased Science

I (Izzy) have been watching a lot of John Oliver lately, and I admit that writing this week’s issue feels a bit like rattling off a talk show host’s brain-dump at the beginning of an episode.

In the two weeks since our last issue, a new executive order on childhood vaccines was issued, the Centers for Disease Control and Prevention (CDC) got a new permanent director (a position that had been previously vacant for a year), the U.S. Food and Drug Administration (FDA) approved the first mRNA flu vaccine, the American Academy of Pediatrics (AAP) released its recommendations for the coming flu season, and the committee responsible for certifying U.S. measles elimination status started its annual review.

Suffice it to say, if you thought August would bring lazy days at the beach, guess again. Let’s discuss…

The Executive Order

On August 10, President Donald Trump signed an executive order titled “Delivering Gold Standard Childhood Vaccine Recommendations for Americans.” In addition to recommending fewer vaccines for kids, the order advocates for splitting the measles, mumps, and rubella (MMR) vaccine into three separate standalone vaccines, among other steps.

Naturally, the terminology of an executive order carries a certain weight, and the formality may make people question vaccine decisions they have made, or think new scientific evidence has emerged that triggered the order. An executive order is a mechanism for the president to communicate and collaborate with different federal agencies, but it is not a law.

If you’re feeling overwhelmed and don’t take anything else from this brief, here are the most important things you need to know: (1) If you are a clinician or are wondering how this executive order changes anything for your family, it doesn’t. (2) As of August 11, 30 states have announced they are no longer relying solely on the CDC’s vaccine recommendations, and will rely on external expert groups such as the AAP instead. (3) Single MMR shots are not manufactured or approved in the U.S., so it would not be possible to receive them separately even if desired.

Now, onto a bit more of the nitty gritty. We covered the executive order at length in a piece we published on August 11, but the order mainly does four things:

1. Calls for splitting the MMR vaccine into three separate shots, once such products are available domestically. None are licensed here, and Merck said in 2009 it wouldn’t resume production. Bringing them back would require a manufacturer to restart, generate evidence, and secure FDA approval. This would be a multi-year process.

2. Advises that childhood vaccines be given at separate visits. At the signing, the president suggested five separate visits at the one-year mark.

3. Sorts vaccines into three tiers: recommended for all children, recommended only for children at high risk, and left to shared decision-making with your child’s doctor. The White House fact sheet puts the universal tier at 11 diseases, down from the 18 the CDC recommended in 2024. Feeling a bit of deja flu? This mirrors the change that the Department of Health and Human Services (HHS) attempted in a January memo, which a federal judge blocked in March.

4. Directs pressure at states, advising them to reconsider school requirements and directing the Justice Department toward litigation over religious and medical exemptions. Since states set school requirements, this has the most practical reach.

Dorit Reiss is a professor of law at UC Law San Francisco, specializing in vaccine law, and has walked through the legal mechanics of the order with CIDRAP, CNN, Time, and on her own Substack. Vaccine recommendations are set by the Advisory Committee on Immunization Practices (ACIP) and the CDC director through a rigorous legal process that an executive order does not usurp. But the order places pressure on individual states, and it adds additional confusion and uncertainty to what has already been a year of vaccine policy whiplash. Within hours of the executive order being issued, Republican Senator Bill Cassidy, the chair of the Senate Health, Education, Labor, and Pensions (HELP) Committee and also a physician, stated plainly that “this executive order is wrong.” He was joined by statements of concern from several professional organizations such as the AAP, American Medical Association (AMA), and American College of Physicians, emphasizing that splitting the MMR vaccine would mean more shots for equivalent protection.

Measles Review Happening This Month

This month, the U.S. National Verification Committee for the Elimination of Measles, Rubella, and Congenital Rubella Syndrome will review the CDC’s annual report on measles and forward its assessment to the Pan American Health Organization. A formal decision regarding the U.S.’s measles elimination status will be formally announced in November. Noel Brewer, who chairs the committee, wrote in STAT about what the panel will weigh, and one number gives a sense of the problem: the country has recorded measles cases every single week since January 2025.

The CDC has confirmed 2,465 measles cases in 2026 as of August 6, past the 2,289 reported for all of 2025, which was itself the highest total since 1991. Among patients, 93% were unvaccinated or had unknown vaccination status, and 68% are age 19 and younger.

This is particularly head-scratching against the backdrop of the new executive order calling for MMR to be split apart and childhood vaccines spread across more visits.

Flu Vaccine Updates

Approval of the First mRNA Flu Vaccine

Moderna’s mFlusiva vaccine was approved for adults aged 50 and older on August 5, and the company has confirmed that doses will start becoming available at retailers in the next couple of weeks. In a phase 3 trial of 40,805 adults in 11 countries, the mRNA option outperformed the standard vaccine at preventing illness.

The measurable end point in flu vaccine trials is usually non-inferiority—that is, that the vaccine under study does not perform worse than what already exists. This type of end point is useful for comparing vaccines with different side effect profiles. Moderna’s mRNA vaccine went a step further, clearing the criteria for superiority, meaning that it was statistically more efficacious at preventing the flu compared to standard-dose recipients.

AAP Has Posted its Flu Recommendations for 2026-27

On August 10, the AAP published its technical report and recommendations for influenza prevention and control in children for the upcoming 2026-27 flu season. Children 6 months and older are recommended to receive an age-appropriate flu vaccine before the end of October, unless there is a medical reason not to do so. The flu vaccine will be covered through commercial insurance and available at no-cost through the Vaccines for Children program.

Last season underscores the importance of the flu vaccine for kids, as they carry a heavy burden of adverse flu-related outcomes. The 2025–26 season was severe for kids, with 190 pediatric deaths, and roughly 85% of the children who died were unvaccinated. Flu vaccine coverage through mid-May was only 49.4%, about the same as the year before.

CIDRAP/Unbiased Q&A Series Launched

This week, Unbiased Science and CIDRAP co-launched a new Q&A series, where we try to respond to your vaccine questions in near real-time. Our first series covered some common questions we’ve received about the flu vaccine. We hope it’s a useful resource for clinicians and families, alike. You can send your questions along to us at vaccines@unbiasedscience.com.

Time to Fix Vaccine Injury Compensation

Reiss also has an August 4 CIDRAP commentary arguing that the Vaccine Injury Compensation Program (VICP) is overdue for repair. While serious vaccine injuries are incredibly rare, they are real, and the program built to compensate affected individuals has fallen badly behind.

Congress established the VICP through the National Childhood Vaccine Injury Act of 1986, after litigation over the whole-cell pertussis vaccine threatened to push manufacturers out of the market and leave children without access. Claimants don’t have to prove that anyone was at fault, certain injuries occurring within specified time windows are presumed to have been caused by the vaccine, and legal and expert fees are covered even when a claim doesn’t succeed.

Most of her piece backs a bipartisan bill from Reps. Lloyd Doggett (D-TX) and Lloyd Smucker (R-PA) that would add special masters (the judges who hear these claims) to clear a backlog, raise a compensation cap that has sat at $250,000 since 1986, extend the filing window from three years to five, and move COVID-19 claims out of the less generous Countermeasures Injury Compensation Program. Previous efforts to reform the program have stalled in Congress, but there seems to be an opening in which real work could be done to improve the program that is essential to keeping vaccines available at all, and exists precisely because the alternative nearly emptied the market.

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Personnel

• Dr. Erica Schwartz was confirmed as CDC director on August 5, 51 to 44, with Sen. Tim Kaine (D-VA) the only Democrat voting yes. She spent 24 years in the U.S. Public Health Service Commissioned Corps and served as deputy surgeon general during the first Trump administration. The agency had gone nearly a year without a confirmed director, since Susan Monarez was ousted in August 2025 for refusing to fire CDC scientists and pre-approve vaccine policy changes. Five days after Schwartz’s confirmation vote, and before she’d even been sworn in, the executive order made vaccine policy her first major test.

• Nominations are open for the National Vaccine Advisory Committee. The Federal Register notice published August 12, with nominations due within 30 days. This is the committee whose charter HHS rewrote in July without announcing it, adding a directive to consider non-immunization strategies including healthy lifestyle initiatives, dietary supplements, and off-label use of approved drugs.

State Policy Round-Up

• Maine expanded access. LD 2071 took effect July 29, letting pharmacists administer any FDA-licensed vaccine consistent with recommendations of professional medical organizations and eliminating copays under state-regulated plans, with a companion bill adding liability protections for pharmacists. In practice, a Mainer needing a tetanus booster or shingles vaccine can get it at a pharmacy rather than waiting for an appointment, which matters in a state projected to be short 120 primary care physicians by 2030. On August 11, the Maine CDC confirmed that its childhood recommendations and school requirements aren’t changing.

• South Carolina’s vaccine policy changes are less dramatic than the headlines suggest. The state’s Department of Public Health reminded families that 12th graders now need two doses of varicella and sixth graders two doses of hepatitis A vaccine, effective July 1. They’re new to those grades, but this is a rolling phase-in rather than a policy change: the 2025–26 letter applied the same requirements to 11th and fifth grade, and the 2026–27 letter moves them up one grade, following a cohort through the school system.

• Texas has been in the hot seat for both measles outbreaks and vaccine policy issues. However, the state health department confirmed that vaccine requirements for 2026–27 are unchanged and that any change would have to come from the state legislature, which reconvenes in January. The underlying numbers merit some attention. Compared to last year, 18 fewer counties hit the 95% kindergarten measles benchmark, and counties where at least 5% of kindergarteners have a conscientious exemption on file rose from 98 to 132, about half the state.

What Else We’re Watching

• Autism was frequently mentioned at the executive order signing, but to date no legitimate study has found an association between the timing of the MMR vaccine and subsequent autism diagnoses. Twelve days earlier, researchers published a study of 2,560,035 children in the Pediatric Infectious Disease Journal. Among those who got a first MMR dose between 11.5 and 24 months of age, the adjusted estimate for autism was 0.97, where 1.0 would mean no difference between groups, with a range of uncertainty from 0.91 to 1.03. The researchers specifically examined whether the timing of the first MMR dose matters, since the vaccine is traditionally administered during the same time that a child’s developmental differences may become more noticeable at home.

• The Senate voted to hold Dr. Anthony Fauci in contempt. The Homeland Security Committee voted along party lines after Dr. Fauci, the former head of the National Institute of Allergy and Infectious Diseases, invoked the Fifth Amendment at the July 29 hearing, and the Justice Department decides what happens next. In a commentary piece, CIDRAP Director Dr. Michael Osterholm asks an important question that the legal proceedings seemed to skirt around: How will we ensure the U.S. is better prepared for the next pandemic?

• HHS published its regulatory agenda. The semiannual inventory of rulemakings HHS expects to undertake lists “ensuring the safety and efficacy of our vaccines” among its priorities, but the vaccine-adjacent entries are mostly placeholders. We’re watching two: (1) a pharmacovigilance rule whose legal authority includes the vaccine adverse-event reporting provision of the 1986 Act, and (2) a pediatric study plan rule touching exemptions from pediatric study requirements. Neither has text yet.

Though there has been an absolute flurry of headlines, the practicality is that not much has changed for families and childhood vaccination. Your pediatrician’s recommendations are the same, the vaccines are the same, and at least 30 states are poised to keep it that way. What’s changed is how much noise and confusion exists for parents trying to make the best decision for their children, and that worries us a lot as we head into a new school year with measles at a 35-year high.

What are you hearing from your own clinicians and school nurses this month? Tell us in the comments or email us at vaccines@unbiasedscience.com.

Stay Curious,

Unbiased Science

Note: this piece is cross-posted with CIDRAP.

Yesterday, life imitated art. A big part of what we do at Unbiased Science is anticipate vaccine hesitancy and figure out how to talk about it, which means spending a lot of time thinking about what makes a parent pause in the exam room. The signing of the executive order on childhood vaccines was a demonstration reel of every technique we warn people about, delivered from the most powerful podium in the country. If we were building a training module on how to manufacture parental doubt, we’d have a hard time improving on it.

So, what actually happened, and what does it mean for our families? Let’s discuss…

What the order says

President Trump signed an executive order titled “Gold Standard Childhood Vaccine Recommendations.” By its own account, it builds on a December 2025 presidential memorandum and a May 2026 executive order that committed the administration to the same policy, so this is the third pass at it rather than a standalone action. Two provisions matter most for parents:

1. The measles, mumps, and rubella (MMR) vaccine should be given as three separate single-disease shots, once such products become available domestically.

2. All childhood immunizations should be administered at separate medical visits, to the maximum extent feasible. The president illustrated this at the signing by suggesting that at one year of age, a child should have five separate visits rather than getting the vaccines on the same day.

The order also advises states to reconsider school requirements, directs the attorney general toward litigation over religious and medical exemptions, and calls for alternatives to aluminum adjuvants. It makes no mention of autism anywhere in the text, though autism came up repeatedly at the signing. It does instruct the Department of Health and Human Services (HHS) to guarantee continued availability of combination vaccines, so nobody is pulling MMR off the shelf.

It also sorts vaccines into three tiers: recommended for all children, recommended only for high-risk populations, and left to shared decision-making between parent and doctor. Hepatitis A, hepatitis B, and meningococcal vaccines each appear on two of those lists at once. The apparent effect is to move them out of the universal column, though the order never says so, which is a bit of a headscratcher.

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The separate shots problem

There are no standalone measles, mumps, or rubella vaccines licensed in the US. Merck stopped making them and announced in October 2009 that it would not resume production, saying at the time there was no medical reason to give the three vaccines separately. Bringing them back would require a manufacturer to restart production, generate the evidence FDA requires, and secure approval. That doesn’t happen overnight.

The risk is that many people won’t hear that conditional language and will assume that separate shots are coming, causing some to delay their child’s MMR while they wait for a product that doesn’t exist.

There is nothing on the other side of that trade. CDC’s own page on MMR safety states that no published scientific evidence shows any benefit to separating the combination vaccine into three individual shots. What splitting would produce is six injections instead of two, and read alongside the same order’s guidance on separate visits, six appointments instead of two. A family that delays is giving up real protection in exchange for nothing, during a year in which the US has already logged more measles cases than any year since the disease was declared eliminated here in 2000.

Can they actually do any of this?

For this I turn to Dorit Reiss, who is a professor of vaccine law at UC Law San Francisco and has been walking through the order’s mechanics. The order has a few moving parts:

The claims

CNN and the New York Times have fact-checked these thoroughly. A brief recap with some Unbiased Science flair:

On the number of shots. He said children were receiving 72 jabs, and described doses “the size of a bottle of soda.” PolitiFact took that number apart in January, when the White House put it on a graphic. Seventy-two appears to come from counting every recommended dose across eighteen years as a separate injection (including doses given orally or by nasal spray) and not from an actual injection count. About half are annual flu and COVID vaccine doses, which no state requires for school attendance. Many vaccines are also combined, so a single injection can count as several doses. Most shots contain between 0.25 and 0.5 milliliters, roughly a twentieth to a tenth of a teaspoon.

On antigen load. The shots themselves have gotten dramatically leaner. In 1986, childhood vaccines protected against seven diseases and exposed a child to more than 3,200 antigens, most of them from a single whole-cell pertussis shot that contained roughly every protein the bacterium could produce. Today’s entire schedule protects against 18 diseases using between 165 and 315 antigens, depending on how they are counted. More shots, far more diseases prevented, and roughly 95% fewer antigens than children encountered through vaccination in 1986.

On autism prevalence. He said it was 1 in 10,000 twenty years ago, but CDC surveillance put it at 1 in 110 in 2006. Even going back to the early 2000s, it was about 1 in 150. Shrinking that starting figure makes the rise look far steeper than it was. Diagnostic criteria also broadened substantially over this period, awareness grew, and screening improved, all of which help explain why we identify far more autistic children now than we did in 1990. I wrote about this for the New York Times last year. You can debate how much of the increase those factors account for (and I’d argue the answer is a lot). What you can’t do is assert that they don’t account for it while offering nothing at all in support.

On MMR itself. He said that given together the three components “could be quite lethal.” When a reporter asked whether he had evidence for that, he said what he’d heard is that some people say it that way.

On whether any of this has been studied. A senior White House aide said at the event that nobody has studied the childhood schedule, nobody has looked at it, nobody has thought about it. If I am being generous, the fairest reading is that he meant the schedule as a whole, rather than the individual vaccines. There’s a kernel of truth there. When the Institute of Medicine reviewed the entire schedule in 2013, it found that research hadn’t been designed to evaluate the full schedule as a single package. But it also found no evidence that following the schedule raised major safety concerns, and recommended studying it further using existing health databases, since randomly assigning children to receive all recommended vaccines or none would be unethical. Researchers have done that work since. A 2018 JAMA study used Vaccine Safety Datalink records to test exactly that question, comparing cumulative antigen exposure in the first two years of life against later infections vaccines don’t target, and found no difference. “Nobody has studied it” simply isn’t true.

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I’m confused, too

Aside from the fact that none of this rests on science, it reads as a dangerous and ill-informed political move. And the majority of Americans support vaccines. Kindergarten vaccination rates are slipping and exemptions have hit an all-time high, but most parents still vaccinate their kids, which makes targeting them confusing on its own terms.

Thinking back to The Office, there’s another part of the analogy that stuck with me. Michael isn’t confused about where the line is. He crosses it because the warehouse guys are lapping it up, and they’re the room he’s trying to win over even though they’re not most of the office. Whether that’s what’s happening here I can’t tell you. But the rest of the office did not respond well.

We won’t know the full cost of this for a while, but we can make an educated guess. Andrew Racine, president of the American Academy of Pediatrics, said the announcement’s only purpose is to sow confusion so more people doubt the importance of vaccines. When families get conflicting messages from people who are all supposed to be authoritative, confidence erodes, and it’s children who absorb the consequences. All of this lands with measles at a 35-year high, respiratory virus season approaching, and kids heading back to school.

What especially worries me

Though this may have been a lot of talk without teeth, there are three developments I’m watching especially closely.

Adding autism to the Vaccine Injury Table would open the compensation program to a volume of claims it was never built to absorb. The table works by presuming causation when a listed injury occurs within a specified window after a listed vaccine, so claimants don’t have to prove it from scratch. That’s a good mechanism when the listings are scientifically sound. Autism isn’t, since decades of research across seven countries have failed to link it to vaccines. We’ve written about the injury table twice this summer, and the concern is unchanged: vaccines don’t have to be outlawed to disappear. They just have to become too costly and too legally risky to keep making.

Congress cutting or dismantling the Vaccines for Children program would do more damage to childhood vaccination rates than any recommendation change on paper. VFC was created in 1994, in direct response to the measles outbreaks of 1989 to 1991, and provides recommended vaccines at no cost to children who are Medicaid-eligible, uninsured, underinsured, or American Indian or Alaska Native. It distributed more than 74 million pediatric doses in 2023.

Federal leverage used to force states to change exemption laws is the one this order already reaches, through the Justice Department and through conditions on grantees. It’s why the fourth item above carries more weight than the rest of the document combined.

What changes for your family

Nothing changes today. An executive order does not itself rewrite the federal immunization schedule, and states, not the federal government, set school requirements. At least 23 have said they will continue following AAP guidance, and the order itself states that it creates no enforceable rights.

Nor can you walk into your pediatrician’s office and ask for separate measles, mumps, and rubella shots. They aren’t licensed in the US, so no pediatrician can offer them, regardless of what the order says.

The same goes for insurance. Free coverage under the ACA and eligibility for Vaccines for Children are tied by statute to ACIP recommendations adopted by the CDC director, which an executive order can’t reach.

None of this means Monday didn’t matter. Confusing parents about vaccines has consequences, and the pressure on states could change policy on the ground. But for families wondering what to do today, the answer hasn’t changed. The vaccines your pediatrician recommended last week are still available, and they are still the best protection your child has. The science hasn’t changed either. Measles is exactly as contagious as it was, and your child’s immune system works exactly the way it did before anyone signed anything.

Stay Curious,

Unbiased Science

Somewhere in America this morning, a healthy 34-year-old man with no symptoms and no family history is lying inside an MRI machine that no physician ordered, having paid roughly $2,500 out of pocket for the privilege. Somewhere else, a 52-year-old woman is skipping a mammogram that her insurance covers in full, because she read online that the compression spreads cancer.

Both of these people believe they are taking charge of their health. Both believe they are making the evidence-based choice. One of them has purchased a test with no institutional backing, and the other has declined one that decades of data support.

I have been writing about prevention for six years now (and teaching and preaching it for far longer), and I have made peace with the fact that vaccines will always come with backlash, and that the boring stuff that works (sleep, moving our bodies, nutritious food, social connection) will never trend because there is no product attached to it. What I did not expect was a double standard opening up inside the prevention conversation itself, running on a logic that is stranger than plain anti-science sentiment. Let’s discuss…

The scan everyone is arguing about

Direct-to-consumer whole-body MRI has gone from a curiosity to a category. Prenuvo has scanned over 100,000 people at around $2,499 a pop. Function Health, which acquired the competitor Ezra, has raised hundreds of millions in venture funding. Kim Kardashian has posted about it. Established radiology practices have followed the money in. SimonMed, one of the largest outpatient imaging chains in the country, launched a longevity division in January with scans running from about $900 to $2,200. Its homepage advertises screening for more than a thousand conditions in under an hour, with “no doctor’s referral needed.” The absence of a medical reason to be there is the product.

The evidence has not kept up with the marketing. No major medical society recommends whole-body MRI screening for people at average risk. Current guidelines reserve it for patients with specific genetic syndromes (Li-Fraumeni, for example, an inherited mutation which greatly increases a person’s cancer risk), where the odds of finding aggressive cancer are high enough to justify looking. In May, two radiologists from Michigan and Wisconsin published an editorial in JAMA titled “Elective MRI Screening of the General Public: Buyer Beware,” telling consumers plainly that the harms likely outweigh the benefits.

A 2020 review of whole-body MRI in asymptomatic adults found that 95% of people scanned had some abnormal finding, roughly three in ten had something that needed further investigation, and about 1% turned out to have cancer. The JAMA authors add that a meaningful share of even those cancers are either slow-growing enough that they never would have hurt you or advanced enough that finding them early changes nothing. Everything else in that 95% is a cyst, a hemangioma, or an age-related change — findings a radiologist can usually name and dismiss on sight. Radiologists have a word for these: incidentalomas. Sometimes the incidentaloma is a shadow that nobody can interpret without more tests, and that’s where the harm can show up.

A nonspecific finding can send you into a workup with contrast, radiation, sometimes a biopsy, and a waiting period that can stretch for months or years before anyone can tell you what it was. One of the JAMA authors described how that process reorganizes your sense of yourself, so that you start living as a patient with a problem even when the finding eventually proves benign.

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The bar keeps moving

Earlier this month Andrew Huberman posted about whole-body MRI, making the argument almost everyone in this space makes. He acknowledged the cost and the false positives up front, then set both aside on the strength of what neurosurgeon friends had told him about operating on findings that surfaced because somebody got curious and bought a scan. Neurosurgeons replied in numbers to say this is not their experience. One faculty member at UCSF told USA TODAY that he has never operated on an incidental life-saving lesion found this way, that outside of unruptured aneurysms there is very little they operate on in a truly asymptomatic patient, and that while he would not claim it never happens, he believes it is rare.

A secondhand anecdote was enough to justify an unindicated imaging study, while in the same wellness ecosystem the seven randomized trials behind current mammography guidance get treated as insufficient. The standard of proof we demand scales inversely with how much we want the conclusion, and that tendency belongs to all of us (myself very much included) unless we build in some way to catch ourselves doing it.

There is also money involved. Several of the most prominent voices promoting these scans have paid relationships with the companies selling them (Huberman included), and those relationships tend to be buried in the fine print.

Why the rescue stories work

I understand why the scans are popular, because the stories are extraordinary and have some recognizable faces. Maria Menounos credits a whole-body scan with catching her pancreatic cancer. Last month, Joe Amabile from The Bachelor posted that his Prenuvo scan found a lesion, that follow-up imaging showed a blueberry-sized mass that appears to be a glioma, and that he was headed to Sloan Kettering for a craniotomy. He is 40, and I hope he is fine.

Stories like his are why the scans sell, and they are hard to argue with because arguing sounds heartless. But one person’s outcome cannot tell us whether the practice works for most of us. We do not get to see what would have happened if he had never booked it, and we never meet the people who booked the same scan and ended up in surgery for something that was never going to hurt them.

The Dwyane Wade story is interesting. When he first went public, Wade said the discovery came after urinary symptoms sent him to a physician. In a later interview, he credited the full-body scan. Both accounts can be true in sequence, but the retelling drifted toward the product and away from the symptom that prompted the visit. His mass was three centimeters, a detail that rarely travels with the story, and small kidney masses under four centimeters frequently go to active surveillance rather than surgery. Wade had 40% of his right kidney removed. It was cancer, and I am glad he is well. But the case most often cited for these scans could just as easily be an example of the harm their critics describe.

Now flip the mirror

At the same moment we are celebrating scans that find things nobody needed to know about, mammography has landed on the naughty list in a growing corner of the wellness world. The claims circulating are that these tests were never safety-tested, that compression spreads cancer, that the radiation causes the disease it screens for. None of that is supported.

What people turn to instead is thermography, an infrared scan that measures heat patterns on the skin surface. The FDA has warned that no scientific evidence supports it as a standalone breast cancer screening tool.

The exaggerated claims about mammography aren’t entirely baseless, though. Buried in them is a documented scientific problem: overdiagnosis. And there are honest open questions inside mammography science that researchers argue about in public:

1. How much DCIS (ductal carcinoma in situ, a very early, noninvasive breast abnormality) that we find and treat would never have progressed to anything harmful.

2. Where the starting age should sit, at what interval, and how much of that changes with individual risk.

3. What supplemental imaging should look like for people with dense breast tissue, since dense tissue can hide tumors on a standard mammogram.

Those questions move, sometimes quickly. In 2024 the US Preventive Services Task Force lowered the recommended starting age for biennial mammography from 50 to 40, reversing its own 2016 guidance, and concluded that the evidence on supplemental ultrasound or MRI for dense breasts is still insufficient either way. The guidelines moved toward more mammography at the same moment a slice of the internet decided mammograms were dangerous.

The claims that mammography was never safety-tested, or that it can spread or cause cancer, are different kinds of claims than the questions above, and collapsing them together does a disservice to the people asking those questions in good faith. The overdiagnosis critique is also, by a wide margin, the strongest argument against whole-body MRI in average-risk adults. The wellness internet picked up the overdiagnosis critique and aimed it at the screening tests with the best evidence base while exempting the one it wanted to buy, and that inversion is the part I cannot get my head around.

We already ran this experiment. South Korea saw ultrasound-based thyroid cancer screening spread widely, and diagnoses rose fifteen-fold between 1993 and 2011 while mortality stayed flat. Yet tens of thousands of people developed complications from the resulting surgeries. That is what happens when you screen people who are unlikely to have the disease in the first place, and it is the best real-world case study we have for why thresholds exist at all.

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What is actually being sorted here

I have no evidence that the people buying whole-body MRIs are the same people refusing mammograms, and I doubt the overlap is large in any individual. These are two currents running through the same wellness space, and I spent a while thinking of them as incoherence, the funhouse mirror version where reality is just warped. They are actually consistent with each other, once you stop assuming the disagreement is about screening.

The axis being sorted on is authority. A guideline is somebody else deciding where the benefit stops exceeding the harm for a population you happen to belong to. A whole-body MRI is something you buy with your own money, on your own timeline, because you wanted to know. If the operating principle is that no institution gets to set the terms of your relationship with your own body, then buying the unindicated scan and refusing the recommended colonoscopy are the same move pointed in two directions. They only look contradictory if you assume evidence is the variable. The sunscreen claims run on the same template, where the sun is natural and the SPF is the intervention, so the intervention becomes the suspect.

Underneath all of it, prevention’s success is a non-event. You cannot feel the cancer you did not get, or the outbreak that did not happen. The intervention is the only tangible thing in the sequence, so it absorbs all the causal attribution, including for outcomes it had nothing to do with. It is also why sleep and fiber and friendship will never trend. Their payoff is a subtraction from a counterfactual, and there is no way to post a photo of that.

The COVID of it all

Wellness skepticism did not start in 2020. Goop, raw milk, the vaccine fights of the 2000s, the entire alternative medicine economy, all of it predates the pandemic by decades. COVID did not create this dynamic, but I suspect it accelerated it, and it put a much larger population in the room. Multiple generations confronted their own mortality at the same time, and something like that does not resolve when an emergency declaration ends.

Psychologists have a framework for this called the terror management health model, which holds that thoughts of death push health behavior in different directions depending on how they surface. When mortality is consciously in front of you and you feel able to act on it, you act. When death thoughts run underneath awareness, decisions get driven instead by what the behavior says about you, which is how the same literature ends up explaining sun tanning.

Underneath is a fear of dying, and deciding for themselves is how people keep that fear quiet. That is where the authority instinct comes from. Seen that way, the two people I opened with stop looking like opposites: neither one is really trying to find anything out. He is buying reassurance, and she has found a reason not to look, and both are ways of handling the same fear. That also changes where my sympathy lands. I had been more forgiving of the guy in the Prenuvo tube, since his choice mostly costs him money and hers carries real risk, but if both are fear management, that asymmetry is harder to defend.

The part that gives me the ick

The ick is the same one I get about concierge medicine, where paying more moves you to the front of the line for care everyone needs and most people wait for. Whole-body MRI is that instinct extended into prevention itself. We now have a two-tier prevention economy. The tier with money buys imaging that no guideline supports. The tier without it struggles to access the screening that decades of data do support.

A radiologist at Johns Hopkins warned that popularizing these scans without medical indications diverts scarce capacity from a system that already lacks it. Every hour of magnet time spent reading a healthy 34-year-old’s incidentalomas is an hour not spent on someone with a diagnosis. And the people paying for that hour are, as the UCSF neurosurgeon pointed out, already the people looking after their health. They are the worried well, with insurance and a primary care doctor and the disposable income for an elective MRI. They are already the group least likely to have anything seriously wrong, which makes them the least likely to benefit from finding something and the most likely to be harmed by the cascade that follows. Meanwhile, the population-level prevention infrastructure that runs on public funding and reaches people who cannot pay for imaging like this, is being cut.

None of which is an argument that more prevention is always better, because prevention is not one thing. Whether a test is worth doing comes down to two questions: how strong the evidence behind it is, and how likely you are to have the thing it looks for. Colonoscopy at 45 clears both. A whole-body MRI for a healthy 34-year-old clears neither. That is a judgment only a clinician who knows your own history can make for you, which is why the ACS screening guidelines are a better place to start than anything with a checkout page.

The people who would benefit most from prevention are the ones who cannot get a colonoscopy scheduled within six months, who are choosing between the mammogram copay and groceries, who have not seen a primary care physician in four years. No amount of luxury imaging touches them. Fixing access does.

Stay Curious,

Unbiased Science

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The misinformation was an obvious problem, and we'll walk through some of it below. But it was hard to watch for other reasons, too. When Bash pressed him on how his messaging feeds vaccine hesitancy, he told her she was "repeating it like a parrot,” that all she knows how to do is repeat what she's been told and say to trust the experts. I know that one well because it shows up screamed verbatim in our comments all the time; that we're all just parrots repeating each other, with no independent thoughts anywhere among us. And to put salt in the wound, every time he said the word experts, it came with air quotes.

People far more politically savvy than I are saying the segment was a deliberate play, and I don’t know whether that’s right. What I do know is that hearing this again, and again, and again, while we’re getting hit with outbreak after outbreak (measles, foodborne parasites, you name it), reminds me of an old seawall that’s taken a repeat battering during a hurricane. Let’s discuss…

On air quotes

The air quotes are about who qualifies as an expert. Immunology, vaccinology, clinical medicine, epidemiology, decades of training in any one of them, and apparently none of that training clears the bar on its own anymore.

I know the counterargument, because I see it in my inbox regularly: sure, that’s expertise, but the whole field has been “captured,” so you need people from outside the bubble who will push back. Consensus among these experts (note the purposeful lack of quotation marks) isn’t a club agreeing with itself. It exists because the highest-quality evidence continues to point in the same direction, study after study, country after country, for decades. As a reminder, these are the same folks who are constantly reviewing the evidence and willing to change or update the consensus when new, high-quality evidence arises.

Last June, we already saw what "outside the bubble" looks like in practice, when Kennedy removed all seventeen members of the CDC's vaccine advisory committee (we wrote about that at the time with several colleagues). A federal judge later found many of the replacements were unlawfully appointed, and HHS has since issued a new charter with fewer requirements for members’ expertise. The meetings themselves have been painful to sit through, because what gets platformed there is a kind of skepticism built on misreadings of weak data, presented with the authority of a federal advisory committee.

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Setting the record straight

We’ll be brief, because there are only so many times you can say the same thing. And rather than repeat his claims, we’ll just state what’s true.

1. Measles is not confined to religious communities that don’t vaccinate. The CDC has confirmed 2,371 cases this year, 93% of them in people who were unvaccinated or whose status was unknown, and which is the most annual cases in the U.S. since 1991. While the West Texas outbreak did begin in a Mennonite community, it spread well beyond it, growing to more than 750 cases. This year, South Carolina has been hit hardest, and outbreaks are running right now in Ohio, Utah, Virginia, and Pennsylvania, where more cases were reported in a single week than at any point in the past decade.

2. RSV did not come out of gain-of-function research. First of all, gain-of-function research means deliberately changing a pathogen in the lab so that it gains some new ability, like spreading more easily or infecting a species it couldn’t infect before. Why would they possibly do this? Usually to study how it might evolve on its own and prepare for that. (That’s simplifying an enormous range of ordinary lab work, and only a narrow slice of it is what anyone actually fights about.) RSV was identified in the late 1950s, decades before the molecular techniques associated with modern gain-of-function research existed. It’s also not the biggest killer of kids in this country, though it is the leading cause of infant hospitalization.

3. The U.S. never had the world’s highest mortality rate of COVID-19. Johns Hopkins’ final tracking data put the U.S. case fatality rate at about 1.1%. Peru’s was 4.9%. If we describe the deaths per 100,000 people instead, the U.S. still wasn’t close to the top, trailing Peru and a dozen or so other countries.

4. COVID-19 vaccines did protect children. One study in CDC’s own MMWR found vaccination cut emergency and urgent care visits by 76% in kids nine months through four years, and by 56% in kids five through 17.

5. Pandemic disruptions are part of the story, but not the main part. In conversations with my friend and colleague Dr. David Higgins, he noted that kindergarten MMR coverage fell meaningfully between the 2019-2020 and 2020-2021 school years, driven both by changes in health-seeking behavior and by school closures, since kids who don’t come back to school don’t have the built-in cues to get their school-required vaccines. There’s good data on that effect worldwide, and in plenty of countries, the vaccine itself is administered while at school. So the seed is real. It just doesn’t explain why we have this many measles cases now.

6. It’s not true that the vaccines given during a baby’s first six months have never been studied for a link to autism. This claim points to the Institute of Medicine’s 2012 vaccine safety review, which examined 158 possible vaccine-and-adverse-event combinations across eight routinely used vaccines, drawing on more than 12,000 peer-reviewed studies. For many of those combinations, the committee concluded the evidence was inadequate to accept or reject a causal relationship. I understand why that wording sounds alarming, but it describes the strength of the available evidence, not a signal someone found and couldn’t explain. The committee anticipated exactly this misreading: “inadequate to accept or reject means just that.” On autism specifically, it evaluated the MMR vaccine and concluded the evidence favors rejection of a causal relationship. It also looked at DTaP and autism and found the evidence inadequate, because the one study available came from the Geiers, the same father-and-son pair I wrote about in the Times, and relied on passive surveillance reports with no unvaccinated comparison group. The following year, the IOM reviewed the childhood immunization schedule as a whole and found no evidence it was associated with major safety concerns.

Kennedy also told Bash that the measles vaccine works, that it stops measles in about 97% of cases, and that parents should vaccinate their children. I’m glad he said it. But in the words of JoJo, it’s a little too little, too late. He didn’t say it, and he certainly didn’t shout it, when three people died of measles last year, the first U.S. measles deaths since 2015, two of them young girls in West Texas. What he offered then was vitamin A, which is neither a preventive nor a cure (it’s a supportive treatment, in specific circumstances).

And death is nowhere near the only bad measles outcome. Roughly 1 in 1,000 children who get measles develops encephalitis (brain swelling), and about one in five of those dies. A smaller number develop SSPE, a fatal brain disease that can surface seven to ten years after everyone thought the infection was over. And measles causes immune amnesia: it destroys the memory cells your immune system spent years building against everything else it had encountered, leaving children vulnerable to infections they were already protected from. That can last for years. We’ll be paying for these outbreaks long after the case counts stabilize.

Both my kids go back to school in a few weeks (not that I’m counting down or anything), and measles is exactly the disease that finds an under-vaccinated classroom, since the virus can linger in the air for up to two hours after an infected person has left the room. By November, we'll know whether the U.S. has crossed the twelve-month threshold of continuous transmission that would cost it the measles elimination status it has held since 2000. That's a strange prospect to be facing while Kennedy tells CNN we're handling measles better than any country in the world.

One thing from the CNN interview that’s new

Kennedy told Bash the President asked him to study whether vaccines cause autism. A year ago this month (wow, time flies!), I published a piece in the New York Times walking through some 70 studies on vaccines and autism and showing how the handful claiming a link were built. Here we are.

Last week, a study published in the Pediatric Infectious Disease Journal followed more than 2.5 million U.S. children through age eight and found no association between a first MMR dose received before 24 months and a subsequent autism diagnosis. It looked at childhood autism specifically rather than the full spectrum. The findings sit alongside more than 40 high-quality studies across seven countries and 5.6 million children. CIDRAP has a writeup if you want more.

Every dollar spent relitigating this is a dollar taken from research that could actually help autistic people and their families thrive.

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Numbers with nothing attached to them

We are all drowning in numbers. Every headline has one, every post has one, and after enough of them, the meaning behind them stops registering. A number that should seriously stop you in your tracks and a number that shouldn’t concern you at all show up looking identical. That’s saturation, and it happens to all of us.

Say the odds of something going wrong are 1 in 10,000. That might sound like a risk you’d be willing to take. By itself, the number doesn't tell you what we mean by wrong, or whether it's something temporary or something that has potential to send you to the hospital. It also doesn’t tell you what your risks would look like if you opted to do something else instead. So say you’re offered another option where the odds are instead 1 in a million. Without knowing any of that context, both might just seem rare. But the first carries a hundred times the risk of the second.

A lot of what we spend our days correcting works exactly like this, and it doesn’t require anyone to lie. Encephalitis after MMR happens in roughly one child per million doses. On its own, in a large font, over a stock photo of a baby, that number is terrifying. It stays terrifying until you learn that encephalitis happens in about one in a thousand children who get measles.

So we built What’s the Risk?, a free interactive tool, with support from the Center for Infectious Disease Research and Policy (CIDRAP). Pick a disease on one side and the vaccine designed to prevent it on the other. Every outcome shows up as a square whose size is scaled to show how often it happens, and colored by whether it’s serious or temporary, because a fever that passes in a day and a week in the hospital shouldn’t look the same on a chart. Hover over any square to see the number, a plain explanation, and the source. You can filter by age, and if you can’t picture 100,000 people (I can’t), you can switch the view to 50,000, or even as low as 5,000 people.

It’s not a perfectly clean, apples-to-apples comparison, and we include those caveats on the tool rather than trying to hide them. The disease side assumes you got infected. The vaccine side assumes you got vaccinated. Those aren’t equally likely to begin with, and your odds of catching something and how severe it would be, depend on your age, your health, and how many people around you are vaccinated.

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Also new: RSV vaccines for adults

RSV has an awareness problem more than a trust problem. In a U.S. survey of adults 60 and older and adults with chronic heart, lung, or metabolic conditions, only 43% had heard of it at all, and among those who had, only about a third felt they knew much about it. If that’s you, bring it up at your next appointment. Meanwhile, the CDC estimates that RSV puts 110,000 to 180,000 adults 50 and older in the hospital every year. (I wrote more about that gap for CIDRAP in May.)

For most people, RSV is a bad cold that clears in a week or two. For older adults, and for younger adults with heart disease, lung disease, diabetes, kidney or liver disease, or a weakened immune system, it can move into the lungs or set off a COPD or asthma flare bad enough to put you in a hospital bed. Everyone 75 and up is recommended to get vaccinated, along with anyone 50 to 74 with one of those conditions. Three vaccines are on the market (Arexvy, Abrysvo, and mResvia), and CDC doesn’t rank them, so take whichever one your pharmacy has. Unlike your flu and COVID shots, this isn’t an annual vaccine, and right now one dose is all that’s recommended. Late summer or early fall is the best window, and it can go in the same visit as your other shots (doubling up sometimes makes the sore arm and tiredness worse).

One practical note, because a reader astutely raised it on our recent RSV post (above), Medicare covers the RSV vaccine at $0 out of pocket under Part D, and under Medicare Advantage plans with drug coverage, but not under Part B. If you’re on Original Medicare without a standalone Part D plan, you may be asked to pay. Use an in-network pharmacy, and if you’d rather go to your doctor’s office, check first that they bill Part D directly. (Part D subsidies end in 2027, which affects premiums but not the $0 coverage for the vaccine.)

A favor to ask

If you were once hesitant about the MMR vaccine for your child and later chose to vaccinate, we want to hear what changed your mind. A conversation with a family member? Something you read? A moment that just clicked? We’re studying those turning points, and the parents who’ve been through one know things the rest of us are guessing at. Take the survey here, and if you know a parent who fits, please send it their way.

Stay Curious,

Unbiased Science

I ask because we ran a restrained paragraph about the Senate hearing in our State of U.S. Vaccine Policy piece a couple days ago, and I thought we’d handled it carefully and fairly. Within minutes, we had people announcing they were unfollowing us over our ‘obvious bias,’ and at the same time, others expressed disappointment that we hadn’t said more. If you’ve ever wondered whether there’s neutral ground here, I can report from the field that there isn’t (and I expect a fresh round of both response varieties once I publish this one).

I’ll break the ‘unbiased’ fourth wall here and let you know that I found Wednesday’s hearing absolutely gut-wrenching. It felt like political theatre, a public tarring and feathering staged to give an outlet for six years of accumulated grief and rage. An 85-year-old scientist sat there absorbing all of it, while I watched from my kitchen feeling like I may as well have been on the floor in the fetal position, sucking my thumb.

This is a man who was a chief architect of PEPFAR, a global HIV program credited with preventing an estimated 25 million deaths since 2003, whose earlier work helped turn HIV/AIDS from a death sentence into something survivable, and whose team in the late 1960s turned cancer drugs into cures for several once-fatal rheumatologic diseases. Politically speaking, he is a registered Independent who worked to keep politics out of the science. Colleagues who worked under him for years told The Atlantic they never knew how he voted, and he received the Presidential Medal of Freedom from George W. Bush before Barack Obama called him a once-in-a-century public health leader.

So in case there was any doubt, I admire and stand with Dr. Fauci. That doesn’t make him perfect or untouchable, and I’ll get to the parts that bother me.

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There’s been a lot written about Dr. Fauci this week and I don’t want to restate what others said well. But my friend Katelyn’s piece resonated a great deal with me in the way she wrote both about Dr. Fauci as a person and what came for the rest of us who spoke publicly about COVID-19 on a much smaller stage. The number of threats and the level of harassment and unbridled hatred hurled my way in those early days of Unbiased Science still blows my mind (it was bad enough that law enforcement got involved). Almost everyone I know in this field has a version of that story.

Watching the hearing on Wednesday, I realized that we seem to be living in two completely different realities. There’s a concept in epidemiology called recall bias, where people with different outcomes remember the same ‘exposure’ differently, and that feels relevant to this situation. What each of us lost shaped how we remember what happened. Someone who watched their business fold and their eight-year-old lose a year of in-person school remembers the restrictions in high definition, with the death toll as background noise. Others remember the bodies piling up on hospital floors, the chaos, a front-row seat to an infectious disease bloodbath that those of us who’ve never donned scrubs cannot really wrap our minds around. Each of those is a true account of a different piece of the same event, which is a large part of why we can’t seem to talk to each other about it.

I took a deep breath and went back through the 2020 news cycle to check my own version against the tape. Let’s discuss…*

(*Sorry in advance, this is long-winded.)

Roll the tape

The dominant story right now is that Dr. Fauci's diary reveals a private man who understood the costs of what he was recommending, standing in contrast to a public one who never admitted those costs existed. Nicole Russell's USA Today column ran on that premise, and it’s far from the only one.

Now, this isn’t an exhaustive history, but here’s what I found based on a cursory internet search:

So the position that he never acknowledged any of this is verifiably inaccurate. How that translated into what he actually recommended, and to whom, is a different question.

The parts I can’t settle

Senator Rand Paul, who chairs the committee, released Dr. Fauci's private diary ahead of the hearing. The entries include March 2020 calls with former NYC mayor Bill de Blasio and with California Governor Gavin Newsom’s chief of staff, in which Dr. Fauci recorded that closures followed from his recommendation and his television appearances. In January 2024, he told a House subcommittee that he wasn’t involved in local decisions to close schools. I don’t have the full record and I’m not going to adjudicate a man’s honesty from selected excerpts of a private journal. But ignoring the tension would be its own kind of dishonesty.

The Fifth Amendment is similar. I’m not a lawyer. My lay understanding is that invoking it is standard counsel whenever criminal exposure is on the table, and that it isn’t evidence of guilt. Whether the pardon took that option away is being asserted just as confidently, mostly by people who aren’t lawyers either. A pardon can remove the privilege for conduct it covers, but not for conduct outside its window, and not for exposure you create by testifying. Sen. Paul himself called it a legal question the courts may have to decide.

COVID-19's origins are another issue. His diary shows that scientists disagreed about whether a lab origin could be ruled out on a February 2020 call, which is roughly what you'd expect scientists to be doing three weeks into a novel outbreak. WHO’s scientific advisory group concluded in June 2025 that the weight of the evidence points to zoonotic spillover, but that every hypothesis would remain on the table because China still hadn’t turned over early genetic sequences, market data, or lab biosafety records. Whether what Dr. Fauci said publicly in 2020 tracked what he actually believed is a fight I don’t have the standing to referee.

I understand the frustration, both from people hoping he’d finally clear his name, and from people hoping he’d finally be pinned down. They wanted the same thing on Wednesday, which was for him to actually answer, and nobody got it. That frustration and his lawyer’s advice can both be reasonable at the same time and I don’t think you have to pick.

About the masks

People bring up mask guidance a lot.

On March 8, 2020, Dr. Fauci said on 60 Minutes that “people should not be walking around with masks.” Within weeks, the CDC was recommending cloth face coverings for everyone. Later, the guidance moved again, toward N95s and away from cloth. And along the way, Dr. Fauci acknowledged that part of the early advice had to do with preserving a rapidly dwindling PPE supply for the people who needed it most. That last part makes people very angry; to them, it reads as: he had information, he decided we couldn’t handle it, and he told us something else.

The defense at the time was that evidence for community masking was thin, and that public health believed asymptomatic and presymptomatic transmission was rare, which would have made masking the general public close to pointless. Both beliefs turned out to be wrong.

Criticisms haven’t only come from his opponents. Emily Erbelding, who ran a division at NIAID under him, told The Atlantic the communication around the reversal wasn’t good, and that it landed as no masks, then suddenly everyone must mask. Ryan Bourne at the Cato Institute sharpened the point: thin evidence justified saying masks were no silver bullet, or saying nothing at all, and it didn’t justify telling people not to wear one. In his reading, that “don’t” was partly a supply decision dressed up as science.

The following summer, in July 2021, when the CDC reimposed indoor masking for vaccinated people, Dr. Fauci explained on PBS NewsHour that his earlier recommendation was built around the Alpha strain, that Delta spread differently, and that vaccinated people with breakthrough infections could transmit the virus. The virus had changed and the advice changed with it. At this point, though, a lot of people had learned to read a shift in mask guidance as a sign that someone upstream was managing them.

Vaccine mandates come up almost as often. In that same PBS interview, asked whether the federal workforce should be required to vaccinate, he said he thought mandates were needed but that the right place for them was where an employer has authority over its own employees rather than a nationwide one from the president. He pointed specifically to the VA’s requirement for its health care workers. Whether that distinction survived contact with how mandates actually rolled out is the same question as the school closures. (I know the follow-up: the case for mandates leaned partly on stopping transmission, and what the vaccines could do there shifted as the virus did. That’s a whole piece on its own for another time.)

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“The states that stayed open did better.” Based on what measure?

The other thing I keep running into is some version of that sentence, delivered with total certainty and almost never with a denominator attached. This is the part where my training is relevant, so bear with me through a little program evaluation.

1. The studies frequently don’t say what they’re cited as saying. The University of Chicago paper in PNAS is the one I see invoked most, usually as proof that the closures accomplished nothing. Read it and the claim narrows a lot. The authors studied one policy instrument—shelter-in-place orders—across one stretch of time (late February through May of 2020). They found those orders moved mobility by less than a percentage point, against a national backdrop of roughly a 50% mobility drop over the same window, because people had overwhelmingly already changed their behavior on their own. Their conclusion says outright that the findings should not be taken to mean government officials had little effect on the pandemic, and that the national response almost certainly did slow the spread. The argument is that the orders added little on top of what people were already doing.
   

2. States were not randomly assigned their policies. This piece from the Competitive Enterprise Institute makes the broader version of the argument, ranking states by the Oxford stringency index and comparing outcomes. The problem is that states locked down because they were being hit. The outbreak drove the policy as much as the policy drove the outbreak. New York was seeded early and repeatedly out of Europe, back when travel restrictions were still focused on China, and it landed in the densest city in the country, where several million people share subway cars every morning and families share small apartments across three generations.

   Then add the calendar. March in New York means everyone is indoors. March in Florida means people can be outside, and outdoor transmission of a respiratory virus runs at a fraction of indoor transmission. The PNAS authors flag this same problem in their own work, stating that the parallel trends assumption underneath their design is suspect, because policymakers may have imposed orders exactly when things were already heading the wrong way. A footnote in the same paper reports that the median state with a Democratic governor issued a stay-at-home order at 1.2 cases per 10,000 residents, while the median state with a Republican governor waited until 4.1.
   

3. “Lockdown” is not one thing. It bundles school closures, bar and restaurant closures, mask requirements, gathering limits, and stay-at-home orders into a single score, and those have wildly different evidence bases and costs. Collapsing them into one dial is a good part of why this argument has gone in circles for six years. You can’t answer “did it work” until you say which one, measured how, against what alternative, over what window.
   

   The same thing happens in the other direction. I’ve watched people who’d agree with everything else in this piece share red state versus blue state mortality charts, hand-drawn causal arrows and all, as proof that lockdowns worked. Same flaw. We need to hold ourselves to the same standard.

   
   None of this means the critics of lockdowns and mask mandates were entirely wrong. Kids lost ground and plenty of them still haven't made it back. The Education Scorecard, a Harvard, Stanford and Dartmouth collaboration, tracks district-level achievement for roughly 35 million students in grades 3 through 8. Its latest report finds middle-income districts received little of the federal relief money and remain far behind where they were in 2019. The economic damage was real too, though assigning a precise share of it to the closures runs into a problem I’ll get to below. A lot of us in public health were slow to say any of this out loud, and the defensiveness cost us.
   

   The same report dates the start of a national “learning recession” to 2013, and finds that in reading, the annual decline in the three years before the pandemic was as large as the decline during it.
   

   The harder problem is that we can measure what the closures cost, because those costs happened to us. We can’t measure what they prevented, though, because prevention is invisible when it works. There’s a name for this in public health, the prevention paradox. Do the job well and you end up in a room full of people asking why you bothered. Every cost of the closures has a face and a household attached to it. The deaths that didn’t happen have neither, because there’s no list of them and never will be. We know what the spring of 2020 looked like in New York with those measures in place. What it would have looked like without them exists only in models. A model is useful, but it is a structured argument about a counterfactual world that didn’t happen, and the results move along with the assumptions you feed it. Which is how the same University of Chicago team could take one of the most-cited estimates of lives saved, rerun it, and land somewhere entirely different.
   
   That limitation applies to me as much as to anyone. I can’t prove to you that the closures saved the number of people I believe they saved. And “did they work” was never really the whole question anyway, because a two-week closure and a year-long one aren’t the same intervention, and the case for the first is far stronger than the case for a year of it. Dr. Fauci said as much himself in that 2024 CBS interview. What I can say is that “the data prove the closures did nothing” isn’t a finding, it’s a guess about a world that never existed.

The lettuce

Very recently, I could not figure out what to tell people about lettuce. We’ve been covering the Cyclospora outbreak, which involves a known pathogen, and I still sat there paralyzed over whether to say avoid all fresh produce, or just greens, or just greens in the affected states, or nothing at all. Every version was going to either scare people off vegetables they had no reason to fear or leave someone exposed who didn’t have to be. I lost sleep over it and I was only writing a newsletter. Nobody’s livelihood was riding on my answer and no school district was waiting on me.

Now scale that up by a factor I can’t fathom, add a pathogen nobody on earth had seen before, remove most of the data, add politics, add the global economy, and set the deadline for this afternoon. Woof!

I came across a photo of my husband, Ethan, and his coworkers in their ER, back in 2020 when we lived in Florida. They’re giving a thumbs up. They’re wearing cloth masks, the ones I helped coordinate from a local woman who wanted to do something, because there was no PPE and the N95s being reserved for exactly the people in that photograph weren’t reaching them. What I understood at the time was that cloth might offer some protection, and something seemed better than nothing. I understood far less then about particle size and how much actually passes through fabric. Once I did, I cringed, and then I spent weeks trying to get N95s and respirators into that department, which was close to impossible given what the supply chain looked like that spring.

So the information I was working from changed and I changed with it, and not one person has ever asked me to account for the first version.

Six years later

A lot of us in this space talk about ‘BC’ and ‘AC,’ before and after COVID. To be clear, the virus itself is very much still here, but the world on either side of early 2020 doesn’t feel like the same place. It changed us, and worse than that, it divided us, and a great many people I respect have spent years trying to repair some of what broke. (I have, too.)

Which is part of why Wednesday was so hard to sit through. Watching claims about “experimental gene therapy” and “thousands of vaccine deaths,” none of them supported by any evidence, broadcast from a Senate hearing room to the entire world, six years on, was a reminder that those claims haven’t faded… they’ve been handed a bigger stage.

Ethan lived apart from us in an Airbnb for a stretch of that first spring. He’d come by with the PPE carved into his face in valleys and his eyes so bloodshot from what he was seeing that I had trouble looking straight at him. We had conversations about who would raise our children. We wrote letters to them assuming that we might not get to see them grow up. My friends who worked in New York still can’t talk about the refrigerated trucks and makeshift morgues; it’s just too painful. The people who actually stood in those rooms are, almost without exception, the ones least eager to tell you what anyone should have done.

We still haven’t agreed on what we’re measuring, or over what stretch of time, or against what alternative. Until we do, we’ll keep digging our heels in, each of us insisting our reality was the right reality. Wednesday was never going to settle any of that, and I don’t think it was ever meant to.

Stay Curious,

Unbiased Science

In the three weeks since our last issue, the Senate Committee on Health, Education, Labor, and Pensions (HELP) advanced nominees to lead the Centers for Disease Control and Prevention (CDC) and Administration for Strategic Preparedness and Response (ASPR), state legislative sessions closed out with a full tally of how this year’s vaccine bills fared, the Department of Health and Human Services (HHS) rewrote the charters of two federal advisory committees in ways that go well beyond routine renewal, a federal religious exemption bill landed in both chambers, and the Bundibugyo Ebola outbreak in the Democratic Republic of the Congo (DRC) kept outpacing the vaccine development meant to catch up with it.

We have some catching up to do! Let’s discuss…

Featured Resource

State legislators were flooded with vaccine bills this season. A New York Times interactive analysis counted more than 400 vaccine-related measures from August 2025 to July 2026, and 209 of the measures aimed to weaken vaccination rules or erode public trust in vaccines. The proposals hit every part of the vaccination system, including school and daycare requirements, legal protections for people who are unvaccinated, mRNA and COVID-19 vaccines, and messaging that casts vaccines as dangerous.

Only nine of the bills became law, and no state eliminated its core childhood immunization requirements, though Arizona and New Hampshire came close. Among the bills that did pass, laws in Louisiana, Mississippi, and Oklahoma will now require recent vaccinations to appear on the death reports of infants and children, which observers tie to a debunked claim linking vaccines to sudden infant death syndrome.

A dozen states moved in the other direction by passing laws to protect childhood vaccination recommendations after federal officials tried to limit them. Vaccine critics are already drafting new bills for next session, and they consider this year a win even though most of their measures failed.

Breaking: One Step Closer to a CDC Director

Thursday morning, the Senate HELP Committee advanced two of President Donald Trump’s nominees. Both nominations now head to the full Senate floor, where confirmation votes have not yet been scheduled.

The first nominee was Dr. Erica Schwartz, nominated to become the next director of the CDC. As a board-certified physician and former deputy U.S. surgeon general, she brings conventional health credentials. While she has no public record of opposing vaccines, there were concerns following her confirmation hearing that she would not be willing to stand up to HHS Secretary Robert F. Kennedy Jr. on vaccine-related topics. Senator Tim Kaine of Virginia was the only Democratic senator to vote in favor of Dr. Schwartz, and she received full Republican support. The CDC has not had a permanent director since August 2025, and Dr. Jay Bhattacharya has been serving as acting director while simultaneously leading the National Institutes of Health (NIH).

The second nominee was Sean Kaufman to lead ASPR, which is the government’s health security agency. He received full support from Republicans while all Democrats unanimously opposed the nomination. During Kaufman’s confirmation hearing, HELP Committee Chair Sen. Bill Cassidy had clashed with him on some of his comments questioning vaccine safety.

Ultimately, while Cassidy voted yes, his vote came with contingencies, including that Kaufman could not be involved in any vaccine policy decisions. In Cassidy’s words: “We know that some individuals in HHS may continue to make decisions undermining confidence in vaccines and public health…the administration is committed to continuing the work to remove vaccine misinformation from the website [referencing changes made to the CDC’s measles, mumps, and rubella (MMR) page about unsupported links between the vaccine and autism]. That is something again that I’ll pay close attention to.”

Federal Actions

The Guaranteeing Religious Accommodation in Childhood Education (GRACE) Act would strip federal education funding from any school that refuses to honor religious exemptions from its vaccine requirements, and it would also bar those schools from asking families to document the belief behind the exemption. Rep. Greg Steube filed the House version last August, and on July 23rd Sen. Mike Lee introduced a Senate comparison with cosponsor Sen. Tommy Tuberville. The bill has picked up endorsements from more than 50 organizations, including Children’s Health Defense (CHD), Make America Healthy Again (MAHA) Action, and Moms for Liberty.

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The National Vaccine Advisory Committee (NVAC), which advises HHS on vaccine safety and use, received a new charter dated July 7th that the department did not publicize. The document signals that Kennedy’s team is still working to reshape how vaccine policy is set, even as the White House reportedly pushed to pause some changes before the midterms. Where NVAC once concentrated on the safest and most effective use of vaccines, the new charter tells the committee to look beyond immunizations and consider other ways to limit vaccine-preventable diseases for people who cannot or will not be vaccinated.

It points specifically to healthy lifestyle initiatives, dietary supplements, and off-label use of drugs approved by the Food and Drug Administration. The charter also limits members from academia who received pharmaceutical-industry funding to no more than one-third of the committee and calls for public members to make up at least a third. This charter will run through July 2028.

Ebola Vaccine

The fast-spreading Ebola outbreak in the DRC has accelerated vaccine development, since no vaccine or treatment is currently approved against the Bundibugyo species of the ebolavirus. As of today, the outbreak has infected 3,442 people and killed 1,521.

The Coalition for Epidemic Preparedness Innovations (CEPI) is backing several candidates simultaneously. The University of Oxford began the first human trial of its ChAdOx1 BDBV vaccine last week, supported by a CEPI program worth roughly $8.6 million. The vaccine relies on the same platform as the Oxford/AstraZeneca COVID-19 vaccine and is manufactured by the Serum Institute of India.

Today Merck and the charity Wellcome announced that their joint venture, Hilleman Laboratories, would manufacture doses of a single-dose candidate from the International AIDS Vaccine Initiative that the World Health Organization (WHO) flagged in May as the most promising option, drawing up to $8.5 million from CEPI. CEPI has also committed up to $50 million toward a separate Bundibugyo candidate from Moderna.

What Else We’re Watching

• Gavi, the Vaccine Alliance, funding restored—but with conditions. The State Department agreed to reinstate the $600 million in vaccine funding to help developing countries buy and distribute vaccines. In the announcement, it explicitly stated it will not channel any U.S. government funding to the WHO through the alliance.

• A tightened federal grip on gain-of-function research. Federal officials shut down what they deemed “dangerous” research and tightened oversight of foreign collaborations. This move has potential implications for both vaccine development and pandemic preparedness. We will keep you updated as we learn more.

• Andrea Shaw is still in the spotlight. Last issue, we covered the case of Shaw, an Idaho mother who claimed on a CHD-produced show that her 18-month-old twins died shortly after receiving vaccines. Since then, three separate doctors familiar with the clinical data have formally stated that the vaccines could not have caused the deaths.

• Kennedy has been asked to disclose whether his family will profit from the recent Gardasil vaccine settlement. We covered the settlement in a previous issue. In a new letter written by four Democratic senators, Kennedy was asked more than 20 questions about potential conflicts of interest he may have in the case. A response is expected by August 11.

Monday is the kickoff for National Immunization Awareness Month (NIAM). Voices for Vaccines has created some fantastic content for you to adapt, including templates to write Letters to the Editor and social media graphics and video templates. We’re excited to see how you raise awareness this month.

Also watch this space on Monday for an exciting announcement about a new collaborative project between Unbiased Science and CIDRAP.

Finally, we’d like to close with some parting thoughts on Dr. Anthony Fauci’s recent Senate committee hearing.

We will comment on one thing directly. Watching the hearing was a reminder of how much misinformation about COVID-19 vaccines is still in circulation. In 2026, with mRNA technology built on decades of research and years of real-world safety data behind these particular vaccines, they are still being described as “experimental gene therapy.” That is simply inaccurate, and hearing it repeated on a national stage was disheartening. We still have a lot of work ahead of us on scientific accuracy, and even more of it on trust.

And, rather than weighing in on the merits of the proceedings, we’d instead like to offer a thought exercise. The COVID-19 pandemic presented challenges that few in public health had faced before. And the response, especially in the early days, involved countless decisions made with evidence that was incomplete and changing. Some worked well. Others fell well short of what they were meant to do. Every choice carried trade-offs. To say Dr. Fauci’s position was unenviable would be an understatement, and watching the hearing brought a lot of us right back to the uncertainty of those first months.

→ If you had been in that role, what would you have weighted more heavily? Would you have allocated resources differently?

→ How would you have communicated decisions when the evidence underneath them kept moving?

Share your thoughts in the comments or email us at vaccines@unbiasedscience.com. We want to hear it.

Stay Curious,

Unbiased Science

Note: this piece is cross-posted with CIDRAP.

She is happy and healthy, which is the only part that matters. I am grateful for medicine, grateful for the surgical team that took such good care of her, and grateful that we still got real time with their Babcia. I came home to a longer to-do list than I left with, so let’s discuss...

1. The Cyclospora outbreak, and why your salad is probably fine

I have had multiple friends tell me they are done with salad for the rest of the summer, just to play it safe. That is a completely reasonable response to the information people have been given, and the information people have been given has been a mess. I worked through all of it in an op-ed for CIDRAP published yesterday. Here is the short version.

This is the largest documented Cyclospora outbreak in US history and the illnesses are real. Cyclosporiasis is not a 24-hour bug, and untreated it can run for weeks and relapse. The detective work was excellent. Because Cyclospora will not grow in culture, investigators had no clean genetic fingerprint to match cases across states, so they relied on good ol’ interviews and shipping records. Michigan walked 190 people who had eaten at Taco Bell through their meals ingredient by ingredient, and 90% of them had eaten iceberg lettuce, and the FDA traced the paper trail to a single farm in central Mexico that Taylor Farms says accounts for less than 1% of the US iceberg supply. The recall came July 17. Huzzah, that is the system working!

Where does that leave us today? It is extremely likely that the exposures that drove this outbreak happened in June and early July. Confirmed counts are still climbing because it can take up to six weeks to test someone, confirm the result, interview them, and connect them to an outbreak. A number that keeps going up is not evidence that people are still getting exposed. The implicated lettuce was recalled more than a week ago, and lettuce is perishable, so it cleared shelves quickly.

So, why does it feel like the entire country is under lettuce siege? Because several different things got collapsed into one number. The nine-state outbreak tied to iceberg lettuce accounts for 1,947 confirmed cases. The CDC separately reports more than 4,000 confirmed domestically acquired cases nationally since May. It has now been reported in 41 states. Cyclosporiasis turns up every summer in this country, outbreak or no outbreak, and several states say their counts are about where they normally are. North Carolina thinks its own increase is about parsley and cilantro, neither of which has emerged as a national signal, and the state says outright that its surge does not appear connected to the lettuce outbreak. The FDA is separately investigating a cluster of at least 72 people with no identified source at all. Pulling all of that apart into a clear national picture took until the fourth week of July, which is what happens after years of shrinking federal and state food safety capacity.

The cumulative count tells us how many people got sick, how many landed in the hospital, and whether a state needs to surge resources (all very important). What it cannot do is tell you whether you are likely to get sick this week, which is the thing most people are actually asking. Those are two different questions, and only one of them was getting answered in public.

Now, I am NOT saying this outbreak is no big deal. Under-warning is a serious failure, and if I have to choose, I will always err toward telling people to be overly cautious. But over-warning has costs, too. It frightens people who were never at meaningful risk, pushes people away from produce most Americans already do not eat enough of, costs growers a season, and spends down the trust we need for the next warning. Timing is the piece we handled worst here. The case for telling everyone to be cautious was strong in June, when nobody knew the source. We were still saying it in late July, after the source was identified and pulled.

A fair objection is that we still do not have the complete picture. No product sample has held up as positive, and nobody has established how the parasite got onto the lettuce in the first place. What I would say is that 190 food histories converging on one ingredient, and traceback converging on one supplier, are most consistent with a single contaminated product rather than something broader. If that shifts, I will tell you.

If you are immunocompromised, on chemo, or living with a transplant, take this seriously. Cyclosporiasis runs longer for you, it relapses, and it can bring complications that need clinical attention, so staying careful is warranted. If you have had diarrhea for more than a few days, see your doctor and ask specifically about Cyclospora testing, because a lot of routine stool panels do not include it.

For most everyone else, especially outside the nine outbreak states, I do not think a summer without salad is buying you much. The recall covered product from one farm, and it came off shelves more than a week ago. Check the recall list and skip anything on it. And yes, there is risk. There is some risk every time any of us eats fresh produce, and there always has been. For almost everyone, that trade is still worth making.

Our own messaging, mine included, was broader than it needed to be. The detective work supported a narrow message about one product, from one supplier, in a handful of states. What went out was closer to “be afraid of lettuce.”

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2. Peptides are about to get a lot easier to buy, and the evidence has not changed

Peptides are everywhere in wellness content right now. They are short chains of amino acids that act as signals in the body, and plenty of them are legitimate approved drugs. GLP-1 receptor agonists, which most people just call GLP-1s, are peptides. So is the oxytocin used to start labor. The ones in question here are a different group, sold for wound healing, joint repair, metabolism, and longevity, with names like BPC-157 and TB-500. None is FDA-approved for any of the uses being marketed, and the evidence supporting the wellness claims being made for them ranges from limited to essentially nonexistent. Almost everyone taking them buys from online sellers, mostly overseas, who label the product “research use only” to sidestep the rules.

On July 23 and 24, the FDA’s Pharmacy Compounding Advisory Committee voted to recommend that six of these peptides be added to the 503A Bulks List, the roster of substances compounding pharmacies are allowed to make and sell directly to patients. (BPC-157 cleared eight to six with one abstention on Thursday, with KPV, TB-500, and MOTS-c following the same day, and epitalon and semax clearing Friday. Only emideltide was rejected.)

Compounding pharmacies make customized medications for individual patients when the commercial product does not fit, like a liquid instead of a pill or a formulation without a particular dye. It was built as an exception to the drug approval process and has grown into a multibillion-dollar business that telehealth companies sit on top of.

The vote was also the second move on these peptides in a year. In 2023 the FDA put them on a list of substances too risky to compound at all. This April, it pulled them back off, a decision HHS Secretary Robert F. Kennedy Jr. said would "immediately begin shifting demand away from the black market.“ Last week’s vote would take them from tolerated to affirmatively permitted.

Candidly, this is concerning to me. Here’s why.

The FDA’s own scientists were far more concrete with the committee than “the evidence is thin.” They flagged a real risk that synthetic versions of molecules your body already makes will provoke an immune response, up to and including anaphylaxis (a severe, potentially life-threatening allergic reaction). That risk exists even when the product is made correctly, and it is not hypothetical. Taspoglutide, an experimental diabetes drug built to closely mimic a hormone the body already produces, generated antibodies against itself in about half the patients who took it and systemic allergic reactions in 6%, including anaphylaxis, and Roche stopped dosing patients in the phase 3 trials in 2010. Manufacturing adds a second path to the same place, because errors can slip the wrong amino acid into the chain. Another issue is that several of these peptides do not dissolve well and can come out of solution, so someone injecting at home may get a different dose every time. And epitalon cleared the panel despite FDA scientists warning that long-term exposure could be carcinogenic. The telomere lengthening being marketed as a longevity benefit is the same property that raises the concern.

All of that assumes we at least know what the drug is supposed to be. An FDA staffer also told the committee there is no standardization for these peptides, and that the agency has encountered products all marketed as BPC-157 that contained different active molecules. Another official was even blunter, saying the agency does not know with any certainty what the substance is. My colleague Dr. Leigh Baxt, who has followed all of this closely, points out that most of the injectable substances already on that compounding list have considerably more safety data behind them than these peptides do.

So, how did anyone get to yes? Leigh listened to the entire BPC-157 session, and the affirmative case came down to clinicians describing patients they believe it helped, and an argument that this list does not require proof of safety or efficacy in the first place. That second argument flips the burden of proof. The question stops being whether there is evidence these drugs work and becomes whether anyone can prove they do not. The BPC-157 vote was also nominally about treating ulcerative colitis, and Leigh says almost nobody addressed that indication, including the members explaining their yes votes.

And people really do swear by these, which I want to take seriously without mistaking it for evidence. Most of what BPC-157 gets used for is soft tissue injury, and soft tissue injuries heal on their own. People also tend to start something new when they feel worst, which is when they are most likely to improve anyway. Sincere, confident testimony is exactly what you would get either way, which is the whole reason controlled trials exist. The randomized data we do have on BPC-157 suggest it may perform no better than placebo.

The committee added eight new members last month, six of whom market peptides, and by Science’s count, at least seven people on the panel are involved in companies that sell them. They voted in favor. I do not need to assume anyone acted in bad faith to think a panel should not be setting market access for products its own members sell.

The strongest argument on the other side came from a committee member explaining her yes vote. She described a patient who brought her a research-grade product bought online that turned out to be cut with MDMA. That is the status quo, and it is dangerous. A licensed compounding pharmacy, with manufacturing standards, a prescription, and a record of where the raw material came from, is a real improvement on that.

Leigh put her finger on why that only goes so far. Compounding changes who is allowed to sell you a drug. It generates no new evidence about whether it works, and it will not produce the large controlled trials that would, because those require a company to file an investigational new drug application and fund years of development. If a peptide sells profitably without any of that, the incentive to ever run them gets weaker.

What worries me most is what patients will reasonably conclude. Brian Lee, a USC physician who voted no, warned the committee that this would not be an FDA approval but that people would read it as one anyway, and that impression is very hard to undo. He also noted that harms like liver injury do not show up in self-reported side effects.

None of this is final. The FDA is not obligated to follow its advisory committees, and a decision is expected in the coming weeks. But if the agency signs off, compounding pharmacies will be allowed to make these peptides, and the telehealth companies that rely on those pharmacies can start prescribing and selling them to you. Easier access is not the same thing as better evidence.

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3. Your banana is not destroying your blueberries

A clip from the Mel Robbins podcast made the rounds this week, in which Dr. Rhonda Patrick said she skips bananas in blueberry smoothies. The reasoning is that bananas have high polyphenol oxidase activity, an enzyme that degrades polyphenols, so the banana cancels out what the blueberries are doing for you. My colleague Dr. Kevin Klatt, a nutrition scientist and registered dietitian, went and read the 2023 study behind the claim, and he walked through what it actually measured and where the leap happens. He graciously brought us into the response.

Nowhere in that study did anyone put bananas and blueberries in the same smoothie. The study was about cocoa. Researchers had the same small group of healthy men (eight enrolled, six of whom completed each smoothie day) come back on separate days for a banana smoothie, a mixed berry smoothie, and a capsule with milk, with cocoa flavanol extract stirred into every one of them. What they measured in people’s blood was a compound in plants called epicatechin (and a few other compounds it gets metabolized to). Cocoa extract is a very concentrated source of epicatechin. Bananas aren’t a good source, and neither are blueberries (an apple has much more!). On the banana smoothie day, blood levels were much lower, likely due to the higher enzyme activity in the banana. On the berry day, they were higher, likely because berries have far less of this enzyme than bananas do. Berries were never the focus of the study (cocoa extract was!) and were only there as a comparison for bananas.

Nobody‘s health was measured here. They drew blood over six hours and watched levels rise and fall, which tells you something got absorbed and nothing about whether it made any difference to anyone's health.

Blueberries get most of their health reputation from a different family of compounds called anthocyanins, and those were not measured here at all. So, the actual finding is that adding a banana to an expensive cocoa flavanol-fortified smoothie reduces how much epicatechin you absorb. Whether a banana does anything to the other types of polyphenols in your blueberries is something this study never tested. That headline doesn’t generate buzz nearly as well as “bananas kill the benefits of blueberries.”

The bigger issue Kevin raises is who this content targets. More than 80% of Americans do not eat enough fruit. Advice about optimizing the polyphenol yield of your smoothie is built for people with the time and money to chase every alleged biohack, and it makes a villain out of the one fruit almost anyone can afford and find year-round, while your blueberries keep their fiber and micronutrients no matter what you blend them with. Kevin also points out that the one trial everyone is citing was funded by the company that sells the cocoa extract, which also employed the study’s first author and supplied the extract itself, a depressing reality-check on who is willing to pay for nutrition research at all. His full breakdown (and all of his content) is top notch.

Eat the banana.

Stay Curious,

Unbiased Science

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Shingles has a reputation and, frankly, it’s earned. For a lot of people, it ranks among the most painful things they’ll ever go through, and the pain can outlast the rash by months, sometimes years. Thankfully, we have a vaccine that protects against it, and it works remarkably well. It’s given as two doses, spaced two to six months apart. You sent us a mountain of smart, specific questions about it. Do you need it if you had the chickenpox vaccine? Can you get it early if you’re scared? Do you need it again later? And what on earth is going on with those dementia headlines? Let’s discuss…

The chickenpox connection

First things first, let’s set the stage. If you had chickenpox as a kid, you are still carrying the virus that caused it. Chickenpox and shingles come from the same bug, the varicella-zoster virus (VZV). After you recover from chickenpox, the virus doesn’t actually go away. It retreats into your nerve tissue and goes quiet, sometimes for decades. Later in life, it can reactivate, travel down a nerve, and surface as shingles, a painful, blistering rash that usually appears in a band along one side of the body. Unlike the itch of chickenpox, shingles often causes severe burning or nerve pain, along with fever and fatigue. About one in three people who’ve had chickenpox will get shingles at some point, and the risk increases with age.

Why does it reactivate? The part of your immune system that keeps VZV in check weakens with age, and can also dip with illness, stress, or medications that suppress immunity. When it drops far enough, the virus can reactivate. Still, it’s not entirely clear why some people get it and others don’t.

You can’t catch shingles from someone who has it, which surprises people. It comes from your own dormant virus waking up. What can spread is the virus itself, through direct contact with the open blisters. In someone who has never had chickenpox or the chickenpox vaccine, that contact would cause chickenpox, not shingles.

Your questions, answered

We periodically open up question boxes on our Instagram page, and you submitted some great questions that we address below:

I am worried about side effects from the shingles vaccine. Do people usually feel crappy afterwards?

We won’t sugarcoat it. Yes, Shingrix can be a reactogenic vaccine, which is the technical way of saying it can make you feel lousy for a day or two. A sore arm is very common. Some people also get fatigue, muscle aches, headache, chills, or a low fever. Roughly one in ten people feel rough enough to skip their normal activities briefly. Most people experience mild-to-moderate symptoms lasting two to three days after either dose, and the second dose tends to be the tougher of the two.

Those symptoms are a sign your immune system is responding, which is the whole point. They’re short-lived and a reasonable trade for avoiding weeks of discomfort during a shingles episode or the months of painful postherpetic neuralgia that can follow. (Note that not experiencing these effects does not mean the vaccine didn’t work for you. Everyone’s immune system is different, and some people react more strongly than others.) One practical tip people appreciate: avoid scheduling your vaccine the day before something important, and plan for a quiet next day just in case you don’t feel well.

But even if your first dose hits you hard, see the second dose through! People don’t react the same way both times, and you need both doses for full, durable protection.

Did they come out with a new shingles vaccine? And how is it different from the old one?

Yes, and it was an upgrade!

The older vaccine, Zostavax, was available in the US from 2006 to 2020. It was a live vaccine, meaning it used a weakened form of the virus. It helped, but its protection was moderate to begin with and faded fairly quickly over the years.

The current vaccine, Shingrix, is a completely different design. It’s a recombinant vaccine, which means it contains just one engineered piece of the virus paired with an adjuvant, an ingredient that revs up your immune response. No live virus at all, which is why Shingrix is safe for people with weakened immune systems, who couldn’t safely get the older live version.

The performance gap between the two vaccines is large. In studies, two doses of Shingrix prevented shingles in about 97% of adults ages 50 to 69 and around 91% of adults 70 and up. It also cut the risk of long-term nerve pain (postherpetic neuralgia, more below) by 91% in adults 50 and older, and 89% specifically in those 70 and up.

If you got vaccinated before 2020, there’s a chance you had Zostavax rather than Shingrix. Zostavax is no longer available in the US today, but that’s not a problem. It’s safe to get Shingrix even if you’ve already had Zostavax, and doctors recommend doing so, since Shingrix is more effective and lasts longer.

Do I need the shingles vaccine if I had the chickenpox vaccine as a kid, not the actual illness?

For now, yes, once you reach the recommended age. The childhood chickenpox vaccine uses a live, weakened strain of VZV, and that vaccine strain can also, rarely, reactivate as shingles later. The reactivation rate is much lower than with wild-type chickenpox (the virus from an actual infection, as opposed to the vaccine strain). But the people who received the childhood chickenpox vaccine (introduced in the US in the mid-1990s) are only now reaching their early 30s, so the current age-based recommendation applies to everyone, regardless of how they acquired immunity. As that generation ages, the guidance may get more specific, but it hasn’t yet.

Is 40 too young? Why did my doctor tell me to wait? When should I actually get it, and who needs it?

For most healthy adults, the recommendation kicks in at age 50. That’s the point where shingles risk starts climbing meaningfully, and it’s the age the vaccine was studied and approved for in the general population. So if you asked in your 30s or 40s and were told to wait, that’s why. Shingrix isn’t recommended (or typically covered) for healthy adults under 50, and if a younger person receives a dose by mistake, the guidance is not to repeat it and to hold the second dose until their 50th birthday.

The exception is immune status. Adults 19 and older who are immunocompromised are recommended to get Shingrix earlier, because their shingles risk is elevated well before age 50. This includes people who have a condition or are receiving a treatment like chemotherapy, high-dose steroids, a transplant, HIV, or certain autoimmune therapies.

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Can I get it before 50 if I’m worried? I’m 47 and watching my 78-year-old father suffer through three months of postherpetic neuralgia. I do not want to wait.

First, this is such a human reason to ask. Watching a parent go through months of nerve pain would make anyone want to move now. So, the straight answer:

If you have a healthy immune system, the recommendation still starts at 50, and most providers will hold to that, both because that’s where the evidence sits and because insurance rarely covers it earlier. The reassuring part is that you’re three years out, not thirty. Researchers have noted that shingles rates in people in their late 40s are creeping toward the rates in people in their early 50s, so there’s active discussion about lowering the age. It hasn’t moved yet. When you are eligible, the vaccine is highly protective against the kind of episode your father is going through. Talk to your doctor about your concerns and family history. If you have any condition that weakens your immune system, say so, because that could change your timeline entirely. Ask to be flagged as soon as you qualify.

Can you tell us more for people over 65?

If anything, older adults benefit most because shingles and its complications become more common and more severe with age. Shingrix was studied specifically in adults 70 and older and still performed strongly, around 91% protection against shingles, plus a large drop in long-term nerve pain. Protection runs a little higher at the start and eases down over time, but stays strong for years (see durability, below). If you’re over 65 and haven’t had the vaccine, you have the most to gain.

Do I need a booster dose or another round later? How long does protection actually last?

No booster dose, and no repeat round. It’s a one-time, two-dose series, with no re-vaccination schedule once you finish. The long-term data back that up: a study published in 2025 followed participants for 11 years and found that vaccine efficacy against shingles was 87.7% in adults 50 and older, measured from one month after the second dose through the end of follow-up, holding at 82.0% specifically in the eleventh year post-vaccination. There isn’t evidence of the kind of waning that would justify a booster dose, and booster doses haven’t been formally studied. That guidance could be revisited as follow-up data continue to extend, but for today, two doses is the full course.

I forgot my second dose. Or I got my first dose, then got a cancer diagnosis (or life happened) and missed it. After a year, do I need just the second dose, or do I restart?

You do not restart. There’s no maximum interval between the two doses, so whether it’s been six months, a year, or longer, you just get the second dose when you can. Dose one still counts. And if a cancer diagnosis or treatment is now in the picture, that places you in the immunocompromised group Shingrix is recommended for, so finishing the series matters even more. Talk to your care team about timing around your treatment.

Does the recommendation change if I already had shingles, even before 50? Am I more likely to get it again if I skip the vaccine?

You can absolutely get shingles more than once. Most people have a single episode, but second and third episodes happen, so a past bout doesn’t take you off the hook. The recommendation is to get vaccinated at 50 and up whether or not you’ve had shingles before. If anything, having had it is a good reason to protect against the next one. One practical note: if you’re in the middle of an active episode, wait until it resolves before vaccinating. And if your earlier episode was in your 30s or 40s and you’re otherwise healthy, the age-50 timing still applies. Again, the one exception to this is if you are an immunocompromised adult, because your shingles risk is elevated before age 50.

Can I get the shingles vaccine while breastfeeding?

Because Shingrix contains no live virus, it’s considered compatible with breastfeeding, and current guidance supports giving it to someone who is lactating and otherwise due. Pregnancy is handled a bit differently: the usual advice is to wait until after delivery, since there’s less safety data during pregnancy. If you’re pregnant or nursing, check the timing with your clinician.

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The dementia headlines: what’s real and what’s hype

This was the question we got more than any other, so it gets its own section…

Over the past couple of years, a striking pattern has shown up in study after study: people who get the shingles vaccine seem to develop dementia at lower rates than people who don’t. The early, most rigorous evidence came from natural experiments in Wales and Australia, where quirks in vaccine eligibility rules created something close to a randomized comparison, and the vaccinated groups had measurably lower dementia risk. Those studies used the older Zostavax vaccine, which raised the obvious question: does the current vaccine do the same?

In 2026, studies using Shingrix specifically began to answer that. Large analyses of Medicare data found lower dementia rates among vaccinated older adults, with reductions of roughly a quarter to a third depending on the study and population. One analysis of more than 500,000 adults, published in a major internal medicine journal, found about a 24% lower relative risk over four years. The signal keeps appearing across different groups and methods, which is why researchers are paying attention.

Now the caveats. These are observational studies. They can show a strong association, but they can’t prove the vaccine is the cause. People who show up for a shingles shot may also be doing other things that protect their brains, and researchers work hard to adjust for that, though no adjustment is perfect. The natural-experiment designs strengthen the case, which is why the pattern is hard to wave away. Still, a strong, plausible association is not yet proof.

There are real reasons it could be causal. Preventing the virus from reactivating may spare the brain a source of inflammation, and the vaccine’s immune-activating adjuvant may have broader effects. Both are being actively studied.

Where does that leave you? Preventing an agonizing rash and the risk of months of nerve pain is already reason enough to get this vaccine on schedule. Any brain benefit is a possible bonus, increasingly interesting, still unproven, and not the reason to roll up your sleeve. If it holds up, it will be a remarkable bit of good luck on top of an already excellent vaccine.

The bottom line

Shingles is common, it’s painful, and its worst complications can drag on for months. The vaccine that prevents it is among the most effective we have for adults: a non-live vaccine, safe for immunocompromised people, durable for about a decade, and a one-time, two-dose series for nearly everyone.

If you’re 50 or older, or 19-plus and immunocompromised, and you haven’t had it, this is an easy call. Bring your questions and your family history to your next visit and ask whether you’re due!

Many thanks to the American Academy of Family Physicians for sponsoring this Substack article, and for all the work they do! A reminder that we only accept partnerships from organizations we align with and whose work is grounded in evidence. We always retain full scientific and editorial control over our content. These partnerships help make this work sustainable, as do paid Substack subscriptions and tax-deductible donations to our non-profit.

P.S. If you have additional questions, you can comment on this post or email us at vaccines@unbiasedscience.com

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A few things worth flagging before I go quiet. Let’s discuss…

Cyclospora, a culprit at last

We finally have a source. FDA’s traceback investigation converged on a single supplier of iceberg lettuce from Mexico, used by Taco Bell locations across five states (Indiana, Kentucky, Michigan, Ohio, and West Virginia). The FDA advisory counts 1,644 illnesses and 94 hospitalizations, with no deaths reported. Reporting from several media outlets has named Taylor Farms as the supplier, though the CDC and FDA have not confirmed that publicly.

The confirmed guidance is specific to shredded iceberg lettuce served at Taco Bell in those five states. I know a lot of you love the Taylor Farms salad kits in the grocery store. To be totally transparent, I can’t say with 100% certainty that those aren’t affected, but the FDA report seems to focus specifically on Taco Bell. Whether the same lettuce reached other vendors at all is still unclear, so the investigation is worth keeping an eye on.

Someday soon, I would love to do a case study on this; less on the epidemiology than on the broader public health response. The people working this outbreak did remarkable work, full stop. My interest is in how guidance actually reached the public. Hindsight is 20/20, and I will say it about my own guidance, too. Early on, I told my broad audience, not just folks in the affected states, to err on the side of caution and avoid the common cyclospora culprits (greens, berries, herbs, etc.) because we had no confirmed source and cases were still being investigated. That felt like the responsible thing to do. As the days went on, it became clearer that cases were clustered in a few states and that the rest of the country was likely unaffected, aside from the ordinary risk of foodborne illness that comes with eating produce at all (cyclospora included). We did not need to steer the whole country away from produce. Much of that broader worry stemmed from patchy coordination across states and the absence of a single federal voice. That is exactly why a strong federal public health infrastructure matters so much. When it is missing, those of us doing this work end up filling the gap with our best guesses, and the public absorbs the confusion.

So what happens next? The implicated lettuce is being pulled. Taco Bell has committed to stop using the supplier’s lettuce and remove it from its supply chain. That does not mean the numbers stop today, though. Cyclospora has a long incubation period, roughly a week on average and up to two, so people exposed before the source was removed may still be getting sick and showing up in the counts. I would expect cases to keep climbing a little before they level off.

Then there is the legal side. Taco Bell has been here before. A 2006 E. coli outbreak tied to lettuce served at its restaurants sickened 71 people and spun into years of litigation over who would pay up to $76 million. This outbreak has sickened more than 1,600. It would not surprise me to see legal action follow here too.

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A VICP bill worth celebrating

A bill with bipartisan support was just introduced, and we are very happy about it. It would modernize the program that compensates people in the rare cases when a vaccine causes a serious injury, and it would finally bring COVID-19 vaccine claims into that system.

A bit about how this works. The Vaccine Injury Compensation Program (VICP) has been around since 1986. It’s a no-fault system, which means people don’t have to sue a manufacturer or prove negligence to be compensated. It runs on a small excise tax on vaccines rather than taxpayer dollars, and it uses an “injury table” that lists injuries known to be associated with certain vaccines. If someone experiences one of those recognized injuries in the expected timeframe, it’s presumed connected, and they don’t have to prove causation from scratch. Other claims can still be considered, they just require more evidence.

If you’re wondering why COVID-19 wasn’t already included, it comes down to timing. When the vaccines first rolled out under emergency use authorization, injury claims were routed into a separate, more limited program called the Countermeasures Injury Compensation Program (CICP), which was built for public health emergencies. That program doesn’t allow you to appeal a decision, doesn’t cover pain and suffering, and has a large backlog of claims that have been sitting without a decision for years. Even after the COVID-19 vaccines received full FDA approval and were added to the immunization schedule, those claims were never moved into the stronger, fairer VICP that covers other routine vaccines. This bill fixes that.

It is worth noting that what is included on the injury table is very important (we talked about this in our last round up), and we have some concerns about a recent proposal to expand the list to include things that are not verified as caused by the vaccine.

Beyond COVID-19, it would fold in newer vaccines like RSV, shingles, and dengue, cover adult vaccines rather than just childhood ones, add Special Masters (the judges who hear these cases) to clear the backlog, raise compensation caps for the first time since 1986, and give people five years to file instead of three.

Our support for vaccines has always come down to public health. Whatever the comments sections assume, no one is paying us to be pro-vaccine. Vaccines save millions of lives. Vaccines save millions of lives. In the rare instances where someone is injured, we feel strongly that they deserve a fair, timely, and compassionate path to compensation. Standing up for those people and standing up for vaccines are the same thing, and it’s encouraging to see both parties recognize that.

We will share updates as we have them.

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One more thing on measles

Anytime we point to the incredible protection the MMR vaccine offers, the number one response we get is a version of the same question. Why care so much about preventing a disease with such a low case-fatality rate? My latest CIDRAP op-ed is my answer. Measles is not a live-or-die coin flip. The case-fatality rate leaves out immune amnesia, encephalitis, hospital stays, SSPE, and the whole spectrum of harm in between, and the MMR vaccine protects against all of it, not only the worst outcome.

I also recently put together a video explainer on a related question. If the vaccine works so well, why do we care whether YOU get yours? Part of it is that we care about public health and do not want to see anyone suffer needlessly. The rest comes down to some simple arithmetic.

Before I go

Okay, now I’m really logging off. Next week will be light, with one exception. We just wrapped a piece on the shingles vaccine that we’re scheduling now. We got so many questions about this specific vaccine that we put together a full Q&A, and it’s coming your way.

Stay curious,

Unbiased Science

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We covered a lot of ground this past week, from a detective-themed look at why perimenopause hormone labs so often read “normal” when you feel terrible, to medical stigma, to a rise in poison control calls involving Benadryl among teens, to a Substack addressing the viral COVID vaccine turbo cancer myth. All of it is worth reading up on, so be sure to check out our socials, but we picked three to highlight here: Cyclospora, the COVID vaccine injury table, and SSRIs. Let’s discuss!

The Michigan cyclospora outbreak keeps growing, and we have a lead on the source

If you follow us on Instagram, you saw our carousel about this outbreak when Michigan was climbing toward 1,000 cases. It’s kept climbing. The outbreak has now grown past 3,300 cases in Michigan alone and over 5,000 across the country. That’s staggering for a state that normally logs about 50 cyclospora cases in a whole year. There have been dozens of hospitalizations and no deaths, and Michigan is updating its numbers regularly if you want to follow along.

Cyclospora turns up every summer, and the US typically logs thousands of cases a year, so many states are still within their usual seasonal range. New York is one of them. It has one of the higher case counts in the country, but its health department says that’s close to normal for New York this time of year. The unusual surge is concentrated mainly in Michigan. Ohio and Illinois are also seeing counts state officials call higher than normal. There’s also a lag to factor in. Symptoms can take up to two weeks to appear, about a week on average, so the counts we’re seeing now probably trail the actual number of infections.

The big update since our post is that investigators have a lead. More than a thousand patient interviews keep pointing to lettuce or salad greens as the likely source, though no specific variety, grower, or supplier has been named, and other foods aren’t fully ruled out. Traceback is slow with cyclospora, partly because that two-week lag makes it hard for anyone to remember what they ate.

A few practical things. The symptom to watch for is watery diarrhea, often explosive, usually about a week after exposure. It’s treatable with a specific antibiotic, but cyclospora doesn’t show up on many routine stool panels, so a clinician has to order testing for it by name. You also can’t catch it from another person, so isolating from a sick family member won’t protect you here. The exposure already happened, through food or drink.

On the food itself, no amount of washing fully removes cyclospora. Vinegar rinses, salad spinners, and produce washes all help to different degrees, but none are reliable because the parasite clings to surfaces. Heating is the only dependable way to kill it, so cooking produce to 158 degrees is your safest move. Until a source is confirmed, it’s reasonable to go easy on the foods tied to past outbreaks and suspected in this one, mainly lettuce and salad greens, raspberries, basil, cilantro, green onions, and snow peas. Cooked greens and berries baked into things are safe bets, and commercially frozen produce hasn’t been linked to outbreaks either, though freezing itself doesn’t reliably kill the parasite. When in doubt, heat it.

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HHS is proposing a COVID vaccine injury table

We’ve written before about the vaccine injury table and how changes to it can send major ripple effects through the whole compensation system. Now HHS is proposing a rule that would create an official list of injuries presumed to be caused by COVID vaccines. It’s slated for proposal in November, with the public comment period extending into early 2027.

There are actually two compensation programs in play here, and they work very differently. COVID vaccines were never part of the National Vaccine Injury Compensation Program (VICP), the no-fault system with the trust fund most people picture when they think about vaccine compensation. They fall under a separate emergency program, the Countermeasures Injury Compensation Program (CICP), created under the PREP Act.

An injury table works by presuming causation, meaning anything on the list is treated as caused by the vaccine (or other covered “countermeasure”) without the claimant having to prove it case by case. A table is not inherently a bad thing. CICP has been notoriously stingy, with only about 60 COVID claims paid, a median award around $4,000, and roughly 99% of applications rejected. Some listings would be well supported by evidence, since myocarditis after mRNA vaccines is real and documented, particularly in young men (though it’s more common and more severe after catching COVID than after the vaccine). Public health folks like us are not against fair, fast compensation for people with genuine vaccine injuries. We’ve said for years that we want exactly that. The concern is narrower. It’s about whether this administration builds a scientifically sound table or an overly broad one that functions as a government-stamped list of things people can point to as proof the vaccines are dangerous. Secretary Kennedy has publicly called the COVID vaccine the deadliest vaccine ever made, which is false, so a broad list of presumed injuries wouldn’t land in a vacuum. If you wanted to take a sledgehammer to vaccines without banning a single one, improperly building an injury table is one way to do it. A broad, official list of presumed injuries can erode public confidence, fuel a wave of litigation, and prompt manufacturers to ask whether these products are worth producing at all. Vaccines don’t have to be outlawed to disappear. They just have to become too costly and too legally risky to keep making. What actually goes on the table, and how the causation piece gets explained to the public, are the things to watch.

Let’s talk SSRIs, mine included

I’ve been really transparent here about my own struggles with anxiety and depression. I was on an SSRI for several years, and I’ll go so far as to say it saved my life during a particularly dark period. Over time, I noticed some emotional blunting, that muffled quality where the lows get easier but the highs go quiet too, so I went back to my care team and we recalibrated, looking more closely at anxiety versus depression. Medication was never the only thing I was doing for my mental health, but it’s a significant part of it.

I was advised to taper off, and even with guidance and going slowly, it wasn’t a walk in the park. As the blunting lifted, all my feelings came rushing back at once, which was both wonderful and a lot. I’ve always been a crier, and now just about anything sets me off, happy and sad tears alike! That return of feeling is the un-blunting, and it’s separate from the more serious thing to know about, antidepressant discontinuation syndrome.

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SSRIs are in the news because RFK Jr. and HHS have made them a target. In May, Kennedy announced a plan to help Americans get off antidepressants, framing the country as over-medicated, and this month, federal officials convened a panel to draft guidance on tapering people off safely. Parts of that are reasonable and I support them, like careful assessment before starting, meaningful informed consent, and far better access to therapy. The problem is the framing around it. Pinning the mental health crisis on overprescription is, as the president of the American Psychiatric Association put it, an “oversimplification.” The bigger issue is that comprehensive mental health care itself is hard to get: not enough psychiatrists, not enough therapy access, not enough time with clinicians. Medication often ends up filling that gap. A prescription is faster to give than a referral to a therapist with a six-month waitlist. Kennedy has also claimed, without evidence, that these drugs drive violence and even mass shootings, and that they’re harder to quit than heroin, none of which is true. The American Foundation for Suicide Prevention made the same point, noting that decades of research show appropriate antidepressant use lowers suicide risk overall.

On the risk that tapering guidance is meant to address, stopping an SSRI suddenly can trigger antidepressant discontinuation syndrome. The FINISH acronym covers it: flu-like feelings, insomnia, nausea, imbalance, sensory disturbances, and hyperarousal, plus the “brain zaps” some people describe as brief electric jolts. Tapering slowly, over several weeks per dose and with your clinician, keeps it manageable. Better guidance on this is genuinely a good idea, and I say that as someone who just lived it.

We’re covering all of it in our SSRI series on Instagram right now (see parts one, two, and three), from how these meds work to their use in kids and teens to side effects and discontinuation. If the headlines have you worried about SSRIs and memory, the piece Sarah Scheinman and I wrote on whether SSRIs cause dementia explains why a widely circulated Swedish study doesn’t prove the link it seemed to. It was observational, so it can’t establish cause. It also couldn’t rule out that the depression being treated, not the drug itself, was driving the decline. Depression on its own is a known risk factor for cognitive decline. People whose dementia is worsening are also more likely to be prescribed antidepressants to begin with, and the decline the study measured was below what’s considered clinically meaningful. The short version is that we’re not tossing our Lexapro.

Unbiased Scientists in the Wild

A little spotlight on our team out doing their own thing. Go read them, go follow them.

• Dr. Leigh Baxt, our resident translational science and drug development guru, keeps chipping away at the evidence, or lack of it, behind the peptide craze. Her Instagram is full of clear, no-hype breakdowns.

• A big shoutout to Dr. Sarah Berg, who dreamed up this week’s hormone lab work post. We love the creativity! Sarah is also speaking at a virtual congressional briefing on, you guessed it, menopause. It’s called The Menopause Policy Imperative: Shaping the Future of Women’s Health, hosted by Women’s Health Advocates on Thursday, July 23 at 12PM ET, and you can register here.

  

• Dr. Aimee Bernard wrote a really useful guide to science communication: a five-tier framework for adjusting how you explain your work, from a version for fellow specialists down to one simple enough for a classroom of kids, without losing the science. A great read for anyone who explains complex things for a living!

Stay curious,

Unbiased Science

P.S. If this kind of thing is useful to you, the best way to support it is to subscribe and share. If you’re able, paid subscriptions are what keep this work going!

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Three sources are driving the current wave. Angus Dalgleish, a British oncologist, says he’s watched patients relapse after repeat doses and thinks the vaccine suppresses the T-cells that keep cancer in check. Wafik El-Deiry, a US cancer researcher, published a review in January that gathered mostly single-patient case reports and said they add up to a cancer “signal,” while conceding in the same paper that it can’t show the vaccine caused anything. When other scientists picked it apart, he called the criticism censorship and pointed to a cyberattack that took the journal’s site down as proof he was being silenced. Underneath both is a large South Korean study reporting higher cancer rates among people vaccinated against COVID-19. It’s the one piece of population-scale data the claim has, the citation nearly every scary post leans on, so it’s the one we need to look at closely.

First, though, the anecdotes. A sharp oncologist noticing a pattern in their own patients is worth taking seriously (that’s often how real signals first surface). But noticing is where a question starts, not where it’s answered. The answer needs a comparison group, something no single doctor’s caseload can provide, and neither can a pile of case reports. Without one, you can only show that two things happened close together, not that one caused the other.

An oncology practice makes that especially hard, and not through any fault of the doctor. It’s simply where recurrences, delayed diagnoses, and heavy monitoring all cluster, the hardest possible setting to eyeball whether something new is happening. That’s where most of these case reports came from, and case reports are what El-Deiry’s review was built on. Let’s discuss…

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The study everyone is citing

A paper ran in Biomarker Research last year. It’s big: the study covered more than eight million people in the Korean national health system, comparing cancer diagnoses in vaccinated versus unvaccinated people after statistical matching. At one year, the vaccinated group showed higher rates of six cancers, the biggest bumps in prostate, lung, and thyroid. At a glance, alarming. Yet even the study’s own authors are careful here, as stated in their Supplementary Materials: “Although our data provide insights into COVID-19 vaccination–associated cancer risk, our findings do not establish causal relationships.”

The study is on shakier ground than that, anyway. In October, the journal that published it, Biomarker Research, issued a formal expression of concern, alerting readers that problems with the paper had been raised and were under investigation.

The paper ran as a research letter rather than a full study, and its results fall straight into the multiple-comparisons problem: test dozens of cancer types and a few will clear the statistical bar by chance alone. The ones that did here were the common, heavily screened cancers, with one cluster of them pinned on the mRNA vaccines (primarily Pfizer-BioNTech) and a different cluster on the viral-vector vaccines (likely AstraZeneca or Janssen, though the paper doesn’t specify brands), and no biology tying either set together. Buried in the supplementary material, though not the main text, is the further concession that the one-year window is too short to judge cancer, and that reverse causation or surveillance bias can’t be excluded. Independent fact-checkers landed in the same place. Citing the study as proof means overruling the journal, the authors, and the fact-checkers all at once.

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No mechanism that holds up, no signal

Step back from any one paper and the deeper problem is that there’s no demonstrated mechanism and no population-level signal.

The vaccine’s mRNA works in the cytoplasm, is short-lived, and is cleared by the cell’s normal machinery. It’s not written into your DNA. People have proposed mechanisms anyway, such as the idea that the vaccine “exhausts” the immune system, allowing cancer to progress. But a proposed mechanism is a hypothesis, not a finding, and none of these has been shown to happen. After billions of doses, the cancer signal you’d expect from a real carcinogen hasn’t turned up. US cancer registries make it plain: incidence dipped in 2020 as the pandemic delayed diagnoses, then resumed the same trend it was on before the pandemic, and overall cancer death rates kept falling, with no surge tracking the vaccine rollout. That’s the pattern you’d expect if the vaccines weren’t a carcinogen, not what you’d expect if billions of people had just picked up a powerful new one.

There’s a fair limit to admit here. These vaccines are only a few years old, and a cancer with a decades-long fuse wouldn’t show up yet in anyone’s data, theirs or mine, so nobody gets to call the long game fully settled. But look at what “turbo cancer” actually claims: fast, aggressive tumors within weeks or months, dormant disease roaring back right after a dose. That’s a short-fuse claim, and short fuses are exactly what a few years of data can test, and the same registries already ruling out a surge would be showing exactly that: a spike in aggressive, fast-moving cancers. There isn’t one.

Through decades of research, we know that many types of cancer develop slowly, over decades, through multistep cellular changes that induce cancer cell growth. Colorectal cancer is the best-studied example, developing over roughly 40 years. Cancers linked to chemical carcinogens like asbestos or arsenic show a similar timeline. None of the six cancers flagged in the Korean study, thyroid, gastric, colorectal, lung, breast, prostate, are cancers known for rapid onset.

Two claims deserve their own answer, though. Dalgleish points to melanoma recurrence, and the Korean study flagged elevated pancreatic cancer with more booster doses. Neither is the smoking gun it looks like. Pancreatic cancer is already known for aggressive, fast-moving disease once it appears, that’s a feature of the cancer, not a new trigger. Melanoma recurrence is famously unpredictable, showing up anywhere from months to over a decade after apparent remission, which is exactly why survivors stay under long-term surveillance. A relapse near a vaccine dose tells you nothing about what caused it.

If individual cases can’t settle it, population-level data should be able to. The Korean study’s numbers can be explained by issues like timing, screening, and reverse causation. What can’t be explained is the silence in the monitoring systems built specifically to catch rare vaccine harms. No wave has shown up there, and that isn’t for lack of looking. COVID vaccines have been watched more closely than any vaccine in history. That monitoring caught rare harms within months of rollout: myocarditis in young men and a clotting syndrome with the adenovirus versions. A system sensitive enough to catch those would be very unlikely to miss a wave of aggressive cancers.

The claim hit mainstream news last year, when a speaker at a UK political conference tied Dalgleish’s version, with no evidence, to the cancers in the royal family. In response, the BMJ put it to cancer experts, who were blunt: there’s no medical evidence for turbo cancer, no plausible mechanism, and no rise in any cancer after the rollout once you track the numbers. One flagged the darker irony that the same mRNA technology getting blamed here is now behind some of the most promising cancer treatments in development.

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The wrong suspect

Now ask what changed for the entire human population in 2020. Not the vaccine, which came later. A brand-new virus swept through nearly every country on earth. Most people caught it more than once, and it’s still circulating. If you’re going to look for something with the reach and the biology to plausibly touch cancer, the virus is a more sensible place to start than a vaccine that arrived afterward. That doesn’t mean it does. It means it’s a better place to look, and a few researchers have started looking there.

There’s preclinical work suggesting the infection itself, not the vaccine, can wake up dormant cancer cells. Mouse studies out of a University of Colorado lab (see here and here) made headlines for showing exactly that. Dr. Jenn Dowd went looking for the same pattern in people, and it wasn’t there. The human studies making the scary claim leaned on datasets that barely tracked who had actually been infected, or that just restated something we already knew, that COVID raises your overall risk of dying. Cancer deaths didn’t climb at the population level even after nearly everyone caught COVID. So where does that leave me? Unconvinced that either the shot or the infection is driving cancer in humans, though the latter is far more plausible (and that’s where a preliminary lab signal actually is). But more plausible is doing narrow work here. It means the question deserves more study, not that it’s closer to proven.

That points at a problem sitting underneath every study aimed at the vaccine. To pin cancer on the shot, you compare vaccinated people against unvaccinated people and watch for a difference. But by late 2022, nearly everyone had caught COVID at least once, vaccinated and unvaccinated alike. So the unvaccinated were never a clean, virus-free group to measure against. If the whole worry is spike protein or lingering inflammation, the unvaccinated got a bigger dose of both, straight from the infection. Most of these studies never measured prior infection well enough to pull the two apart. The big Korean one couldn’t. And when one study finally waited a realistic stretch before it started counting cancers, the association shrank or flipped.

That same reasoning, spike and inflammation as the culprits, turns on itself. Infection delivers more of both than the vaccine does, and vaccination lowers your exposure to them. The findings people are waving around to argue against the shot are an argument for getting it.

If you’re a survivor and a scary post has you second-guessing your next dose, the National Cancer Institute is blunt about this: There’s no evidence that COVID vaccines cause cancer, trigger a recurrence, or make an existing cancer more aggressive, and they don’t change your DNA. What they can do is make the lymph nodes under your arm swell and light up on a scan for a week or two, a normal immune response and not a returning tumor, though your care team should know about the vaccine before any imaging so nobody misreads it. That’s one benign, well-documented reason a post-vaccine scan can look alarming when nothing is wrong. The NCI’s guidance for people with cancer is to get vaccinated, because the virus is the real danger to them.

The myth carries a cost. mRNA is becoming one of the most promising tools we have for treating cancer, with more than 120 clinical trials (we recently posted about one) teaching immune systems to hunt down tumor cells. Scaring people off it protects no one. It pulls something useful away from the patients most likely to need it, and it spooks the immunocompromised and cancer survivors away from a vaccine that guards them against a virus that can seriously hurt them.

If a post like this rattled you, that reaction makes sense, but it doesn’t make the post right. The term “turbo cancer” is invented. The study everyone is citing argues against the scary version more than for it, and its own journal has attached an expression of concern to it. No proposed mechanism has held up, and the rapid cancers the story predicts haven’t appeared across billions of doses.

So go ahead and turbo-cancel this claim.

Stay curious,

Unbiased Science

We’re excited about this issue. Alongside the usual policy machinery (charters, quorums, briefing schedules, the works), we’re also pointing you to some of our practical, vaccine-related content that answers commonly asked questions. So we hope this issue is informative and interesting, but also useful.

Let’s discuss…

Still No Quorum, Still Grinding Through Briefs

Since our last issue, little has changed in the American Academy of Pediatrics (AAP) v. Kennedy case. The appeal we previously mentioned is moving through on an “expedited” schedule, meaning briefs are traded back and forth at an accelerated pace. The district court has its own schedule running in parallel, and a joint status report and additional briefing are due this month.

While we wait for the case to play out, it’s important to re-emphasize that the formation of a functioning Advisory Committee on Immunization Practices (ACIP) does not hinge on the outcome of this case. In fact, a committee could be seated relatively soon if appropriately qualified members were placed on the committee through the standard vetting process. As it stands right now, the ACIP quorum problem is a choice, not just a scheduling accident.

Flu Vaccines in the Fall

Writing in a MedPage Today op-ed on June 29th, Richard Hughes IV and Will Walters were asked whether flu vaccines will be available this fall without a functioning ACIP. They think so. Guidance from AAP and American Academy of Family Physicians (AAFP) is standing in as the clinical standard of care, Medicare Part B coverage is required by statute, the Vaccines for Children program runs on an October 2024 resolution that applies regardless of flu strain selection, and AHIP (formerly America’s Health Insurance Plans) has renewed its members’ coverage commitment for the season.

The Affordable Care Act (ACA) does less work here than people assume. It requires only that plans to cover vaccines ACIP has recommended, with a long grace period before new ones kick in. Since flu strains change annually, each season’s shot counts as new, so covering it has always been voluntary. Two other rules—Medicaid’s adult coverage requirement and pharmacists’ authority to administer the vaccine—point back to ACIP by reference rather than naming flu, so both have a technical gap with no current-season recommendation.

The saving grace is history, because the flu vaccine has decades of annual guidance behind it. As Hughes and Walters put it, if any vaccine can make it through a season on institutional memory and workarounds, it’s flu.

Finalized ACIP Charter

We covered the back-to-back ACIP charter rewrites in earlier issues, so we will keep this short. The official version is now posted, and CIDRAP published an excellent debrief if you need an in-depth refresher. Our major takeaway is the tiny but significant language tweaks. Earlier versions of the charter explicitly highlighted that committee members should have vaccine research experience. The new charter simply requires members to “represent a balanced range of scientific, clinical, and public health expertise,” which is broad enough to allow members with little to no vaccine experience to be seated anyway.

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High-Profile Legal Cases

Several high-profile challenges were settled over the past two weeks, giving yet another indication that, while state-level policies have been largely unsuccessful in shaping the future of vaccine policy in the U.S., individual cases have moved to the forefront.

A group of employees lost their jobs in 2021 after they were denied a religious exemption for the COVID vaccine mandate. These employees argued that the mandate violated their Title VII right to religious accommodations. A ruling to uphold their dismissal was made at the Second Circuit, so they elevated the case to the Supreme Court. On June 29th, the Supreme Court declined to hear their challenge of New York’s now-repealed vaccine mandate for healthcare workers.

Implication: For now, workers in the Second Circuit can’t claim religious discrimination to get out of an employer’s vaccine requirement backed by a state mandate. The Court’s refusal to hear the case sets no precedent beyond that circuit.

A related suit is running into similar trouble. A federal court in Texas denied class status to FBI employees who alleged the Justice Department discriminated on religious grounds by requiring masking and testing while their COVID-19 vaccine exemption requests were pending.

We previously covered Miller v McDonald (filed in 2023) in which Amish parents challenged New York’s refusal to recognize religious exemptions for vaccines. On June 30th, the Second Circuit reaffirmed its dismissal again, stating that school vaccination requirements are health and safety rules and therefore do not interfere with a child’s religious upbringing. Plaintiffs are expected to re-petition the Supreme Court again.

Implication: In 2019, New York repealed religious exemptions for school vaccine requirements. The Second Circuit reaffirmed that this repeal is, in fact, constitutional.

On June 26th, President Donald Trump’s Religious Liberty Commission delivered a draft report in which several of the recommendations relate specifically to vaccines. In brief, the report frames vaccine mandates as a threat to religious liberty. Among other things, it urges restoring retirement and re-enlistment eligibility for service members who lost benefits over religious exemptions to the COVID vaccine.

Implication: This report is advisory and not binding, so it doesn’t mean anything for now. However, it does illuminate a clear path toward where the administration will push on religious exemptions next (and it lines up with the two New York cases above, as well).

Andrea Shaw is an Idaho mother who became a lead plaintiff in the Children’s Health Defense (CHD) racketeering lawsuit against AAP. Last year on a CHD-produced show, she claimed her 18-month-old twins died shortly after receiving vaccines. The lawsuit was largely built on this claim, but on June 29th, a grand jury indicted Shaw on two counts of first-degree murder. Prosecutors alleged that she suffocated the twins, Shaw denies the charges, and the case has not yet gone to trial.

Implication: This claim of vaccine injury has been used to scare parents away from the recommended childhood vaccine schedule, and in particular, the hepatitis A, DTaP (diphtheria, tetanus, and pertussis [whooping cough]), and flu vaccines. The indictment underscores that each of these vaccines is safe and effective. Two children are dead, and neither the recommended pediatric vaccine schedule nor the vaccines themselves are to blame.

A Permanent CDC Director, Maybe

As a reminder, Dr. Susan Monarez served as director of the Centers for Disease Control and Prevention (CDC) for less than a month in the summer of 2025 before she was fired, and the grounds on which she was fired (e.g. standing up for science) are well-described in her subsequent testimony to the Senate Committee on Health, Education, Labor and Pensions. Jim O’Neill then served as acting director for less than six months. Since February 2026, Dr. Jay Bhattacharya has been serving as both the director of the National Institutes of Health and the acting director of the CDC. The CDC has been operating without a permanent director since August 2025.

Now, a concrete step has been made toward filling that role. Dr. Erica Schwartz, President Trump’s nominee, will appear before the Senate HELP Committee on July 15 for her confirmation hearing. Schwartz previously served as deputy surgeon general during the pandemic, is a board-certified preventive medicine physician, and has no public record of opposing vaccines, which makes her a more conventional pick than some earlier names. Senator Bill Cassidy, who has been openly skeptical of Kennedy’s approach to vaccine policy, chairs the committee and called her “very impressive” after meeting her. If confirmed, she has pledged to divest her healthcare holdings and recuse from matters involving former employers.

Real Vaccine Questions Answered

Nobody hands you an adult vaccine schedule and asks if you have any questions. So we asked our audience what they wanted to know, and answered the most common ones in a paid partnership with the AAFP. A few of the questions we tackled:

• "Every time I get the flu shot, I get the flu. When I skip it, I'm fine."

  The flu shot can’t give you the flu. What people usually feel is either an unrelated bug, an infection from an exposure around the time of vaccination, or the immune response itself. An important note: the flu vaccine is really good at keeping us out of the hospital (and the morgue) but less effective against infection itself. Still, it absolutely can’t give you the flu!

• "Is the HPV vaccine worth it if I'm over 27?"

  It’s one of only two vaccines we have that prevent cancer. Routine recommendation stops at 26, but ages 27 to 45 fall under shared decision-making with your doctor. (Also, make sure your insurance will cover it!)

• "Is my MMR [measles, mumps, and rubella] immunity waning now that I'm 45? Do I need a booster?"

  Most likely not. What matters most is how many doses you got, and antibody blood tests (aka titers) aren't reliable for settling this. If you’re not sure if you’re fully vaccinated, it won’t hurt to get a dose of MMR.

• "Why aren't adults over 23 offered the MenB [meningococcal] vaccine?"

  Risk is highest in teens and young adults and low for healthy adults, which is why it isn't routine over 23. But specific groups (no working spleen, certain immune conditions, lab workers) do need it.

• “Do adults need vaccines like kids do, and whose job is it to tell you when they're due?”

  Vaccines are recommended for adults but not required in the way that childhood vaccines are as a condition for school entry. Your family doctor or clinician should flag what is due, but sometimes it falls on you to ask.

Why do I care if your child has the MMR vaccine if my kid is vaccinated? We made a short video on the question, because it’s one that we hear the most. For the answer, we need to talk arithmetic!

The MMR vaccine is 97% effective, which means that, out of every 100 vaccinated people exposed, about three can still get infected. When measles is rare, that gap almost never comes up, because you barely cross paths with the virus. When measles is circulating widely, the exposures pile up and that small percentage keeps getting tested.

Add in that immunity can wane, and that measles can erase parts of the immune system’s memory (immune amnesia), then the case for community coverage gets concrete fast. Your protection is real, and it holds best when it isn’t being battered constantly.

As always, we have a dedicated inbox for your questions about vaccines and vaccine policy. If you saw something in the news, are questioning a claim a relative shared, or have a burning vaccine policy question you can't get a straight answer to, send it to vaccines@unbiasedscience.com. Your questions shape what we cover.

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What Else We’re Watching

• New emails show how early the federal chill on vaccines began. Reporting revealed that Kennedy directed the CDC to take down any campaigns promoting the flu vaccine in February 2025 shortly after he began his new role. Former CDC official Debra Houry also described the chaos around the new ACIP appointments on Face the Nation.

• A COVID-19 injury table is coming to the compensation system. The Health Resources and Service Administration (HRSA) is preparing a proposed rule to establish a COVID-19 injury table under the Countermeasures Injury Compensation Program, which would let claimants with listed injuries skip proving causation from scratch. A narrow, evidence-based table (think myocarditis after mRNA vaccination, or anaphylaxis in a defined window) is overdue and reasonable. We’re watching the scope, though, because the governing statute requires “compelling, reliable, valid” scientific evidence of direct causation. There is concern about whether the table stays inside that line or gets stretched to support weakly supported claims. The rule isn’t posted yet; we’ll read it closely when it is.

• MAHA parents still vaccinate. A new poll found that 86% of self-identified MAHA (Make America Healthy Again) parents say the MMR vaccine is important to their families and communities. The loud online fights aren't the whole story, and they never were.

Your Voice Matters!

While much plays out at the state and federal levels regarding vaccine policy, you don’t have to have a job in the government or be a lawyer to show up. Here are two places where your voice really matters right now:

1. In Massachusetts, a house bill (H.2554) would eliminate religious exemptions for school vaccine requirements while leaving medical exemptions in place. The formal legislative session ends on July 31st. If you are a Massachusetts resident, it’s not too late to contact your legislators before that window closes.

2. A White House proposal could entirely reshape for ill how federal science is funded and conducted. The public comment period ends on July 13th, and individual comments carry more weight than form letters. Your comment does not need to be long or technical to make a difference. Here is more information about the proposed ruling and where to submit your comments.

One scheduling note: we’re taking a short summer break. We’ll be back on July 30th to catch you up on whatever happens while we’re gone (and, given the pace lately, there will be plenty!) The pause is partly for a very good reason: our own Izzy Brandstetter Figueroa is in the home stretch to defend her dissertation and earn her PhD in epidemiology. Go, Izzy!

Stay Curious,

Unbiased Science

This piece is cross-posted with CIDRAP.

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Stay Curious,

Unbiased Science

I have had a mama bear living inside me for as long as I can remember, long before I had children of my own. My mother and I were the kind of animal lovers who could not walk past a creature in trouble, and we rescued our way through my childhood. We bottle-fed baby birds who had lost their mothers. Heck, we even kept a little terrarium for snails with cracked shells (humid and stocked with a calcium source like crushed eggshells or cuttlebone) to help them gradually repair the shell by secreting new shell material from their mantle. We pulled a kitten out of a car’s tailpipe, and I spent the whole night with him tucked into a papoose against my chest, rocking back and forth without anyone teaching me how. The rocking came from some deep, evolutionary place, an instinct rooted in me long before I understood it. Nurturing was and is in my blood. (Thanks, Mom. ♥)

When my OB placed my son on my chest in December of 2016, that quiet, lifelong instinct moved to center stage. I heard him cry and it took me over completely. Mama bear Jess found her cub in the same breath my son took his first.

The scientist in me loves this part, because none of what I felt was only poetry. There is real, measurable biology behind it. Pregnancy and the months after it actually reshape the maternal brain. Gray matter reorganizes. The regions that handle empathy and vigilance and the pull toward the baby get more active. The amygdala, that little almond of a structure that runs fear and protection, grows more sensitive, soaked in oxytocin, wired to pull a mother toward this one small person above everyone else. Researchers who study this describe new motherhood as looking, in the brain, a lot like falling in love. They also describe something I recognized instantly. The constant looping thoughts. Is the baby breathing? Is he warm enough? Is he okay? A protective circuit running on a hair trigger.

That instinct is biology doing what it evolved to do. But biology can cut both ways...and that same instinct that made me a mother would, years later, nearly talk me out of the very thing my son needed.

My son’s name is Dylan, and I am in total awe of his brain. He is a sponge. Inquisitive. A steel trap who only has to hear something once before he files it away and pulls it back out whenever he wants, which is humbling for a woman who tears the house apart looking for the glasses sitting on top of her head. He asks questions and pontificates about the universe and about humankind, and I just listen, half-marveling and half-lost– fumbling my way through my responses. Bright beyond words. Yes, I am a mama’s-boy mama. Guilty. A million times over.

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There is something else about Dylan. If I let my focus go soft, the way you have to unfocus your eyes to see one of those 3D stereogram illusions, I sometimes feel like my late father is in the room. I try to keep my daddy issues from crowding my mommy ones, but I will not pretend it is not a gift to catch my father’s wit, his brilliance, his sharp tongue, alive again in his grandson. For a second at a time, a man I lost comes back to me in the shape of this boy.

They are alike in another way, too. My father could have been the poster child for a certain kind of restless, motor-always-running mind. ADHD shows up in different presentations. Some people mostly drift and lose track. Others mostly fidget and act before they think. Plenty land in between, a foot in each. That is my dad, and that is Dylan, with the restless end turned up loudest. Genetics sure isn’t subtle.

Dylan had been showing signs for a while, and we grew more aware of them the longer we watched. He could not make it through even part of a family dinner in his seat. He moved as if a motor ran him, his body and his beautiful mind chasing each other, neither one quite able to slow down and let the other catch up. Other times he would be right in front of us and somehow not really there, physically present but unable to focus on what we were saying, so that we often felt like he was talking past us. His teachers noticed it, too. At one point they asked, carefully, whether he might have a hearing problem. (He does not. We checked.) The notes that came home were all gentle versions of the same observation: how hard it was for him to sit still and stay focused, a mind that would not quite settle. Interestingly, none of it touched his schoolwork. He was bright and he excelled. But I could see it somewhere else, in the flickers of frustration from the people around him, in the way it was starting to wear on his friendships. So we raised it at one of his pediatric well visits. His teachers filled out questionnaires. We filled out ours. A formal diagnosis followed. Our pediatrician walked us through the medication options, and together we settled on the one that seemed best for him. The prescription went to our local pharmacy. I picked it up and brought it home.

Yet the medication sat in our cabinet for months, collecting dust. Two parents. One of us a physician, one of us a public health scientist (who had, years earlier, even done pre-clinical research on this class of medication). A real diagnosis from a real evaluation… and we hesitated to give our son the thing that might help him.

Why? I have turned this over and over because I surprised even myself. Part of it was fear of touching the magic. What if the very thing that makes him him got suppressed? Part of it, if I am being honest, was that the traits I would be treating are the same ones that sound like my late father. Quieting them might feel like losing my father a second time. Part of it, plainer still, was that I was not yet convinced it was necessary. I did not want to reach for something Dylan did not actually need. So, I watched. Was this a disorder, or was it just a bright, busy boy being a bright, busy boy? I did not want to medicate a personality, I wanted to be sure.

In this case, I think my mama bear instinct might have protected Dylan right past the point of actually helping him.

Watching him gave me my answer. This was not a phase, and it was not just ‘little-boy energy.’ I could see how much it cost Dylan to be unable to slow himself down. He was not thriving inside the chaos, he was fighting it. Waiting had stopped being caution and started being its own kind of harm. Holding the tools back from him was not protecting him, it was failing him. If I really wanted to be his mama bear, the fierce thing to do was to use those tools.

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So we gave him the pill. This was not a casual decision, and it was not a reflex. I do not leap at every intervention that gets waved in front of me, I weigh the costs against the benefits every single time. I watched my own kid with my own eyes. I listened to the clinicians whose job is to help families through exactly this, and I let what they knew guide me past what I feared. My instinct did its job, which was to make me look closely. The deciding part, I left to the evidence and the people trained to read it. Helping him meant acting, not dismissing. It meant listening to the experts.

And then my son told me what it felt like when he took his medication. He said he could finally slow his thoughts and his body. He said he noticed his own heartbeat for the first time. He said he could pull his thoughts apart from one another instead of having them all at once. And then, in words I am not embellishing even slightly, he said, “I feel like I’m finally in control of my brain.”

So no, I do not doubt my mama bear. I trust her more than ever. But I have learned that trusting her is not the same as obeying her on the spot. Her job is to love Dylan fiercely and to sound the alarm. Mine is to make sure that love leads me toward what actually helps him. Protecting Dylan meant seeing the real threat clearly, and it was never the pill.

I am not the only one who freezes like this. I have heard pediatricians, the people who recommend and give vaccines every single day, describe the exact same flicker when it is their own child’s arm in front of the needle. The evidence is screaming in support. They have given that shot a thousand times. And still, for half a second, their heart flutters and some ancient part of them pauses. They go through with it anyway, every single time, because they know it is the best way to protect the child they love. That evolutionary seed is planted in all of us. So I am not alone in this, and neither are you.

If there is one thing I want you to take from my fumbling, it is this. I am a scientist and a science communicator, and I would never tell you to suppress that instinct. It is one of the truest, most protective things about you, and it is often the first to sense that something is wrong. But the instinct is old. It evolved to guard children from predators and cliffs and cold, not to weigh evidence from a clinical trial. Sometimes it points you exactly right. Sometimes it has not caught up to the medicine, and it aims your fear at the wrong target. Mine did. It told me the threat was the pill, when the real threat was the thing the pill treats. So listen to the instinct, always. Then carry it to the people whose job is to help you make sense of it, and let the evidence carry real weight, especially in the moments when love and fear have clouded your view, the way they clouded mine. The instinct knows that something matters. It does not always know what to do. That part we borrow from the experts.

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For us, the answer turned out to be a small pill that had been gathering dust on a shelf. And the thing I was most afraid of never happened. It did not dim him, and it did not take anything away. If anything, it gave him more of himself. It sharpened the parts of Dylan that will serve him best and turned down the static that had been drowning them out. His spark didn’t come from his restlessness. And on the other side of my fear, my son finally got to feel like himself.

And I think about my father. His ADHD went untreated his entire life, in a time without the language or the tools we have now. He was brilliant and electric, and that same boundless energy and fervor left him misunderstood more often than he deserved, with people frustrated in the wake of it, never quite seeing the man underneath the motor. I cannot help but think how grateful he would be that his grandson does not have to power through without the tools we now have at the ready. Treating Dylan was never going to erase my father. It honors him.

The medicine has made a world of difference for him. Family dinners have gotten longer. He still asks impossible questions about the universe, but now he can sit still long enough to hear the answer, usually from ‘Alexa,’ since I am still mostly winging mine. I am so grateful. There is some guilt mixed in too, because I wish I had not made him wait while I worked through my own fear. But I am trying to give myself the same grace I would offer any of you reading this. The hesitation was never neglect. It was love that had not yet found the evidence standing right beside it.

Stay Curious,

Unbiased Science