The fight over America’s vaccine future

A pivotal series of decisions in the next few months will determine the shape of U.S. vaccine policy for years to come — and influence American's perceptions of the shots as a public health tool. Why it matters: Health Secretary Robert F. Kennedy Jr. came into office promising to restore public trust in vaccines and to scrutinize the medical and pharmaceutical establishment. But his boldest moves have drawn political blowback, along with charges that he's spreading misinformation and debunked theories.State of play: Kennedy shook up precedent and touched off a legal firestorm with moves like limiting who is eligible for COVID shots and narrowing the schedule of recommended immunizations for children.While some of his most sweeping changes have been temporarily frozen by courts, and the actions of a handpicked group of advisers have been stalled, it's possible that Kennedy will try again by appointing a new panel of advisers. What we're watching: The administration is sending signals it will dial back some of its toughest anti-vaccine rhetoric as the midterm elections approach, giving less oxygen to the next round of anti-vaccine candidates.Meanwhile, a decision is expected by the end of the year in a high-profile case the American Academy of Pediatrics and some other groups brought to overturn the childhood vaccine recommendations.Trump offered some encouragement to Kennedy late last month, when he unexpectedly issued an order to realign childhood immunization recommendations with what the administration calls consensus among peer nations. Trump's continued interest in long-debunked links between vaccines and autism remain a wild card in any federal policymaking. Between the lines: Despite the setbacks in court, public health experts say the administration's moves are already having a lasting effect on a public that became more skeptical of vaccines during the pandemic.School immunization exemptions are up, and vaccine skeptics are trying to carve out more accommodations on religious grounds. Red state legislatures continue to try to do away with vaccine mandates, with mixed success.Big majorities of Americans still support vaccines and trust pediatricians over administration officials. But confusion over shifting guidelines, misinformation and fear of side effects are influencing attitudes."A lot of damage has already be done, and it's going to take years to rebuild the trust and integrity that has been destroyed," said Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota.This story is part of an Axios Deep Dive on the policy debates shaping America's future. Read more in the series:America's killer app: The dollar as the world's currencyAI oversight gap could leave a lasting legacyThe power decisions that could shape the next centuryABC's FCC battle could redefine press freedomAmerica's race categories face a stress test