Welcome to our biweekly series in partnership with CIDRAP at the University of Minnesota.
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 PDF version of today’s update is here. Read past installments here and today’s update on the Unbiased Science Substack here.
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.
Reliance on Sources Other Than CDC/ACIP for State Childhood Vaccine Recommendations. Source: KFF’s State Health Facts, last updated August 11, 2026. Interactive map can be viewed here.
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:
- 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.
- Advises that childhood vaccines be given at separate visits. At the signing, the president suggested five separate visits at the one-year mark.
- 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.
- 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.
Treatment effect and 95% confidence interval. Source: Cuzick, J, Sasieni, P. Interpreting the results of noninferiority trials–a review. Br J Cancer 127, 1755-1759 (2022).
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.
Original post can be found on the Unbiased Science and CIDRAP social media pages.
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.
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.