The Vaccine Intelligence Report: August 19-25

The Vaccine Intelligence Report

August 19-25, 2026

The Vaccine Intelligence Report—brought to you by Vaccinate Your Family—provides clear, fact-based updates on vaccine policy, research, and public health each week. This report is part of Viral Truths, a resource designed to cut through the noise, offering concise information to help navigate the evolving immunization landscape. 

THIS WEEK AT A GLANCE:

  • HHS is seeking public input on whether federal vaccine recommendation categories should be changed or expanded, an early step toward implementing President Trump’s new Executive Order on childhood vaccine policy
  • CDC Director Dr. Erica Schwartz addressed agency staff for the first time, emphasizing scientific rigor and transparency and confirming her role on the Task Force on Safer Childhood Vaccines
  • President Trump nominated Dr. Heidi Overton to lead the FDA, drawing early scrutiny over her role in the Administration’s vaccine Executive Order that may cause challenges in her confirmation process
  • As back-to-school season begins, public health officials are warning about rising vaccine exemptions and declining childhood vaccine coverage across states, even as most Americans continue to support routine childhood vaccination
  • The U.S. has reported more than 2,800 measles cases this year, and Pennsylvania reported its first two measles-associated deaths in 35 years; new research estimates that each 2025 measles case exceeded $43,000 in associated costs
  • The DRC is receiving Ebola vaccine doses to support clinical trials and protect frontline communities as the Bundibugyo Ebola virus outbreak continues to accelerate
  • Moderna and Merck announced that their personalized mRNA cancer vaccine improved key outcomes in a late-stage melanoma trial, pointing to the potential for mRNA technology to play a larger role in cancer treatment and future vaccine development

NEED TO KNOW

HHS Seeks Input on Restructuring Federal Vaccine Recommendations

  • The Department of Health and Human Services (HHS) issued a Request for Information (RFI) last week (Aug. 21) seeking public input on whether the categories currently used for federal vaccine recommendations should be changed or expanded.
    • The RFI is intended to support the HHS Task Force on Safer Childhood Vaccines and advance President Donald Trump’s August 10 Executive Order directing changes to federal childhood vaccine policy.
  • Federal vaccine recommendations currently fall into three main categories: routine, risk-based, and shared clinical decision-making (SCDM). HHS is asking whether additional categories should be created, including vaccines that are “recommended, but not during infancy,” “recommended with qualification,” or subject to SCDM with additional qualifications.
    • The Department is also seeking input on whether existing recommendations should offer greater flexibility around the timing and sequencing of doses, including whether vaccines should be administered individually rather than during the same visit.
  • HHS is also reconsidering how SCDM is defined and used, asking whether the designation is sufficiently clear to clinicians and patients and whether it should be renamed—for example, as a “conditional recommendation” or a “recommendation based on individualized assessment.”
  • The review extends beyond terminology. HHS is seeking feedback on how the strength and type of scientific evidence should inform vaccine recommendations, including when randomized controlled trial evidence is limited, and how factors such as individual autonomy, informed consent, and religious freedom should be considered.
  • Changes to recommendation categories could have broad implications for vaccine access and coverage. The RFI specifically asks how any new categories could affect insurance coverage requirements, the Vaccines for Children (VFC) program, vaccine injury compensation, and state law.
    • Almost all insurers are required to cover vaccines recommended by the Advisory Committee on Immunization Practices (ACIP) without cost-sharing, and VFC provides eligible children with free access to recommended vaccines. More than 50% of children in the U.S. are eligible for VFC.
    • Experts have raised concerns that adding new recommendations could affect which vaccines qualify for these coverage protections and could potentially increase patient costs.
  • While the RFI does not directly propose any specific changes to the recommended childhood immunization schedule, it represents an early concrete step toward implementing the Executive Order.
  • Public comments are due September 20 and will inform HHS and the Task Force as they consider possible changes to the recommendation framework.

Schwartz Addresses CDC Staff as Vaccine Task Force Work Begins

  • Erica Schwartz held her first all-hands meeting as Director of the Centers for Disease Control and Prevention (CDC) last week (Aug. 19), telling staff she would advocate for the agency and emphasizing “scientific rigor,” transparency, and honest communication.
    • Schwartz acknowledged the significant challenges facing the CDC, including staff burnout and a leadership vacuum following months of turnover and staffing cuts.
    • The agency has lost more than 3,000 employees—over one-quarter of its workforce—and an investigation found that some congressionally funded programs have become largely inactive because the employees responsible for them were laid off or placed on leave. Schwartz said she plans to meet with staff to better understand these gaps but did not yet outline specific steps to restore the affected programs.
  • During the meeting, Schwartz also confirmed that she is serving on the Task Force on Safer Childhood Vaccines, which has been charged with helping carry out Trump’s recent Executive Order on childhood vaccine policy. Schwartz said the task force had not yet met and has 90 days to report back to the President.
    • For further information on the Executive Order, see the August 12 edition of the Vaccine Intelligence Report.
  • Schwartz’s role on the task force comes as the Administration moves to advance additional vaccine policy changes. President Trump had reportedly expressed frustration with the pace of federal work on vaccines and autism before issuing the Executive Order, while some allies of HHS Secretary Kennedy have continued to advocate for additional changes to federal vaccine policy.
    • Kennedy is also overseeing a series of federal studies examining vaccine safety and potential associations with autism, autoimmune disease, and other conditions. Medical experts note that a possible causal link between vaccines and autism has already been extensively studied and consistently rejected by decades of scientific evidence.
  • Schwartz’s participation places the CDC Director at the center of the Administration’s next phase of vaccine policy development. The task force’s work—and the role of scientific evidence and agency expertise in shaping its recommendations—will be important to watch as federal childhood vaccine policy continues to evolve.

Trump Nominates Heidi Overton to Lead FDA, Drawing Early Scrutiny Over Vaccine Policy Role

  • On Wednesday (Aug. 19), President Trump formally nominated Heidi Overton, Deputy Director of the White House Domestic Policy Council, to serve as FDA Commissioner. Overton is a physician and former America First Policy Institute official who has helped advance several of the Administration’s health policy priorities.
  • Overton played a visible role in the recent vaccine Executive Order, which called for changes to childhood vaccine policy including separating the combined measles, mumps, and rubella (MMR) vaccine into individual shots. At the event, Overton said the Administration still recommends measles vaccination for all children but wants parents to have more information about timing and the option to separate doses.
  • Her nomination drew immediate scrutiny from Senate Health, Education, Labor, and Pensions (HELP) Committee Chair Dr. Bill Cassidy (R-LA), who said he has “strong concerns” about Overton’s lack of managerial experience and said her role in the vaccine Executive Order “calls into question her commitment to standing up for sound science and protecting children’s health,” calling it “almost disqualifying.”
    • Others also raised concerns about Overton’s vaccine policy role and experience. Chris Meekins, a former Trump HHS official, said Overton’s nomination raises concerns about continued “anti-science and anti-vaccine messaging” within the Administration’s health agenda.
    • Industry and former agency officials also questioned whether Overton could stabilize FDA after months of leadership turnover, pointing to her limited regulatory and management experience and concerns that her nomination could deepen tensions among FDA staff.
  • Her path to confirmation could be difficult. In addition to Cassidy, Democrats have also signaled opposition, and some MAHA-aligned activists have criticized her over concerns that she has not gone far enough on their food, pesticide, and chronic disease priorities.
  • If confirmed, Overton would take over FDA at a time of continued leadership turnover and scrutiny over the agency’s approach to vaccines, drugs, and other medical products. The agency is currently led by Acting Commissioner Kyle Diamantas, as several major FDA centers continue to operate without permanent directors.

STATE POLICY

Florida Moves to Drop Four Vaccines from School-Entry Requirements

  • The Florida Department of Health proposed a rule (Aug. 24) that would eliminate school-entry immunization requirements for hepatitis B, chickenpox (varicella), Haemophilus influenzae type b (Hib), and pneumococcal disease. The changes would apply to public and private schools.
    • Florida law specifically requires immunization against diseases including measles, mumps, rubella, polio, diphtheria, pertussis (whooping cough), and tetanus, while allowing the state Department of Health to add requirements for other diseases through regulation.
    • Because the four vaccines targeted by the proposal were added through agency rules, the department can remove those requirements without legislative approval.
  • The changes would also broaden the state’s religious exemption language to include a “sincerely held moral or ethical belief” and allow parents and college students to opt out of having their immunization records included in Florida’s statewide vaccine registry.
    • During this year’s session, the Florida Legislature attempted to advance a bill expanding religious exemptions, but the measure failed twice.
    • Notably, Florida Catholic Bishops have reaffirmed the importance of vaccination and have pushed back on state Attorney General James Uthmeier’s efforts to enforce religious exemptions.
  • This proposed rule comes on the heels of the recent Trump Administration Executive Order, which calls on states to consider reducing school immunization requirements, and calls for expanding religious exemptions and separating the MMR vaccine into three individual vaccines.
    • The move follows a broader effort announced by State Surgeon General Dr. Joseph Ladapo and Governor Ron DeSantis last year to completely eliminate childhood immunization requirements in Florida. Eliminating the remaining requirements written directly into state law would require action by the legislature.
    • Ladapo approved the proposed rule (Aug. 20). It is now subject to a 21-day public comment period before it can be finalized.
  • Doctors, educators, parents, and lawmakers have condemned efforts to scale back Florida’s immunization schedule, arguing it would leave children and communities more vulnerable to vaccine-preventable diseases.

Back-to-School Season Overshadowed by Growing Vaccine Exemption Rates

  • As the back-to-school season begins across the country, public health officials have sounded the alarm about rising rates of vaccine exemptions.
  • In the 2025-2026 school year, 4.2% of kindergarten students received an exemption for at least one vaccine, a 17% increase from the 2024-2025 school year, according to CDC data.
  • Even as vaccine exemptions rise across the country, nearly 76% of Americans support routine childhood vaccinations. Many support access to vaccines but still have questions or anxieties about them, making them vulnerable to conflicting vaccine safety and efficacy messaging.
  • State and local governments set school vaccine requirements and all 50 states and DC currently require certain vaccines for school attendance; however, jurisdictions can choose how they allow parents to claim exemptions from school requirements.
    • All states permit medical exemptions, while 45 states and DC permit religious and/or personal belief exemptions. States also differ on documentation and review needed to obtain an exemption.

OUTBREAK OUTLOOK 

Two Measles Deaths Reported in Pennsylvania as U.S. Outbreaks Continue to Grow

  • On Tuesday (Aug. 25), Pennsylvania health officials announced two measles-associated deaths among unvaccinated residents of Lancaster County—the state’s first measles-related deaths in 35 years.
    • The Pennsylvania Department of Health emphasized that measles can cause serious complications, including pneumonia and brain swelling, and that the measles, mumps, and rubella (MMR) vaccine provides the best protection against the disease.
    • Pennsylvania has now reported 393 measles cases across the state in 2026—an increase of 86 cases in the last seven days, along with 70 hospitalizations.
    • The deaths are the first recorded in the U.S. this year. The country recorded three deaths due to measles in all of 2025.
  • As of August 21, the U.S. has reported 2,813 cases in 2026—an increase of 181 cases since last week. Several states have reported new or continued measles activity:
    • California reported a measles case in Orange County—the state’s first case since the week of July 27. With this addition, California has reached 59 total cases.
    • Connecticut officials confirmed the state’s third measles case this year.
    • Illinois has recorded five total cases in 2026, following the confirmation of a new case in Kane County.
    • Iowa’s measles outbreak has grown to 17 total cases as of August 24—an increase of five from last week.
    • Georgia reported its eighth case of 2026 last week (Aug. 19). Last year, the state reported 10 total cases.
    • Kentucky’s measles outbreak has grown to 29 confirmed cases and two hospitalizations as of August 26—an increase of five cases from last week. All cases are among individuals who are unvaccinated or have an unknown immunization status.
    • Maryland has declared a measles outbreak in three counties after adding 14 new cases over the last week, with the state’s total reaching 31 cases so far this year.
    • Ohio has recorded 99 cases—up 20 cases since the last newsletter.
    • Oregon has reported 46 cases this year as of August 19, adding just one new case since last week.
    • Wisconsin’s measles outbreak has grown to 61 confirmed cases as of August 25, an increase of 14 cases from last week.
  • New Johns Hopkins research published last week estimates that each U.S. measles case in 2025 cost $43,204 on average, underscoring the significant financial impact of measles outbreaks.
    • This cost rose to an average of roughly $58,600 when also accounting for public health costs, which include case investigation, contact tracing, quarantine, and vaccination campaigns.
    • Researchers note that measles outbreaks, and their significant costs, are largely preventable through vaccination and system-level preparedness.

DRC Receiving Ebola Vaccine Doses as Outbreak Accelerates

  • The Bundibugyo Ebola virus outbreak in the Democratic Republic of the Congo (DRC) is reportedly killing one person every 30 minutes and spreading about three times faster than the 2014-2016 West Africa outbreak—the deadliest Ebola outbreak on record.
  • The World Health Organization (WHO) announced this week that the DRC will receive 70,000 doses of the Ervebo vaccine from the United Nations (UN) international vaccine coordination group to support clinical trials and protect frontline communities.
    • Ervebo is approved for use against the Zaire strain of the Ebola virus. Although it is not known whether Ervebo protects against the Bundibugyo virus causing the current outbreak, early laboratory data indicate it may provide partial protection.
    • 20,000 doses are allocated for a Phase 3 clinical trial assessing the impact of Ervebo on Bundibugyo virus, while the remaining 50,000 are reserved for frontline health workers and communities.

REALITY CHECK

CLAIM: Covid vaccination during pregnancy increases the risk of miscarriage.

  • REALITY: This claim is not supported by the evidence and is often tied to a misreading of preliminary CDC pregnancy registry data collected early in the Covid vaccine rollout.
  • Early data from CDC’s Covid Vaccine Pregnancy Registry—which monitored pregnancy outcomes among women vaccinated shortly before or during pregnancy—did not show an increased risk of miscarriage.
    • Early analysis reported 104 spontaneous abortions among 827 completed pregnancies, or 12.6%, which researchers said was similar to average miscarriage rates (roughly 10-20%).
      • However, researchers later clarified that the denominator of 827 completed pregnancies did not sufficiently represent the full sample of nearly 4,000 participants.
    • The inaccurate claim that vaccination caused an 82% miscarriage rate came from incorrectly narrowing the calculation to a small subset of pregnancies with known early outcomes, while excluding many ongoing pregnancies that had not yet reached a final outcome.
  • Larger studies conducted since the initial vaccine rollout have consistently found no increased risk of miscarriage after Covid vaccination.
    • A CDC-led JAMA study of more than 105,000 pregnancies found no increased odds of miscarriage after Covid vaccination in the preceding 28 days.
    • Another JAMA study of more than 100,000 pregnancies found that Covid booster vaccination during early pregnancy was not associated with miscarriage during either 28-day or 42-day risk windows.
    • A New England Journal of Medicine analysis also found that the risk of miscarriage after mRNA Covid vaccination before conception or during pregnancy was consistent with the expected risk.
  • The broader evidence on Covid vaccination during pregnancy is also reassuring. There is no increased risk of negative maternal, pregnancy, or infant outcomes associated with maternal vaccination, according to a meta-analysis of nearly 640,000 pregnant women across 41 countries.
    • The American College of Obstetricians & Gynecologists (ACOG) continues to recommend the use of updated Covid vaccines for pregnant women and underscores that Covid mRNA vaccination during pregnancy is not associated with increased risks of pregnancy loss, preterm birth, or congenital anomalies.
  • By contrast, Covid infection during pregnancy can increase the risk of complications affecting both mother and baby, including preterm birth and stillbirth. Further, infants born to mothers who were vaccinated during pregnancy have a significantly lower risk of severe disease and hospitalization during the first six months of life.

WHAT TO WATCH

ACIP Set to Meet in October as Respiratory Vaccine Season Approaches

  • ACIP is scheduled to meet October 21–23, though planned meetings in March and June were canceled amid ongoing litigation. The committee has not yet issued updated recommendations for the 2026–2027 respiratory virus season.
    • The committee typically holds three meetings each year to review scientific data and vote on vaccine recommendations. Ordinarily, ACIP would have voted on updated vaccine guidance for the fall respiratory season during the June meeting.
  • However, seasonal vaccines are continuing to move forward. The FDA selected the XFG variant for updated 2026–2027 Covid vaccines, and 2026–2027 influenza (flu) vaccines are already becoming available.
    • Importantly, the absence of new ACIP guidance does not mean existing respiratory vaccine recommendations or coverage have disappeared. Current recommendations remain in place unless they are changed, and most health plans are required to cover recommended vaccines without cost-sharing.
    • State health officials, such as those in Washington, have also emphasized that flu, Covid, and RSV vaccinations will remain available this fall despite the canceled June ACIP meeting.
  • Medical organizations are also moving forward with independent seasonal guidance. The American Academy of Pediatrics (AAP) recently issued its updated flu vaccine recommendations and plans to publish its 2026–2027 Covid and RSV guidance on September 2.
    • Other organizations, including the American Academy of Family Physicians (AAFP) and ACOG, are also expected to publish updated guidance in September.

Congressional Democrats Press Administration to Rescind Vaccine Executive Order

  • More than 90 Democratic lawmakers are calling on President Donald Trump to rescind his recent Executive Order directing changes to federal childhood vaccine policy. The letter was led by Senate Democratic Leader Chuck Schumer (D-NY), Senator Michael Bennet (D-CO), and Representative Dr. Kim Schrier (D-WA).
    • Lawmakers raised concerns about provisions that would separate combination vaccines, change the timing and sequencing of childhood vaccinations, and encourage states to reconsider school immunization requirements. They argued that the changes could increase confusion and barriers to vaccination as measles cases and nonmedical school exemptions remain elevated.
    • The lawmakers also noted that separate measles, mumps, and rubella vaccines are not currently available in the U.S. and argued that requiring additional vaccination visits could create logistical and financial barriers for families.
  • The letter does not compel the Administration to change course, but it signals growing congressional scrutiny as HHS begins implementing the Executive Order. Additional oversight, legislative efforts, or implementation challenges could emerge as the Administration develops its next steps.

First mRNA Cancer Vaccine Succeeds in Late-Stage Melanoma Trial

  • Moderna and Merck announced that their personalized mRNA cancer vaccine, when added to existing treatment, slowed the return of melanoma and its spread to other parts of the body in a Phase 3 clinical trial.
    • The mRNA-based vaccine, intismeran autogene, is tailored to each patient using genetic information from their tumor. The vaccine trains the immune system to recognize and attack cancer-specific mutations.
    • In the 1,137-participant trial, patients received the personalized vaccine in combination with Merck’s immunotherapy drug, Keytruda, following surgical removal of melanoma.
    • The developers reported statistically significant and clinically meaningful improvements in both recurrence-free survival and distant metastasis-free survival, making this the first mRNA cancer vaccine to show benefit in a randomized Phase 3 trial. Full study results have not yet been released.
  • Experts say the results could represent an important advance in cancer treatment, with the potential to become part of standard melanoma care, while also demonstrating the broader promise of mRNA for future vaccines and therapies.
    • Moderna and Merck are already studying similar personalized mRNA approaches in several other cancers, including lung, bladder, kidney, pancreatic, and gastric cancers.

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