President Trump signed an executive order Monday related to childhood vaccines in an Oval Office ceremony, flanked by top health officials and a conservative commentator who talked about her child and her current pregnancy. Those attendees called the move "historic" and "a big deal."
But what's different today when it comes to childhood vaccine policy in the U.S.? Not much. There's no new research, no new vaccines available and no immediate change to insurance coverage or school requirements.
And so far, pediatrician Dr. Jennifer Shu in Atlanta says parents in her practice aren't asking her about what the executive order means for their kids.
"At the very beginning, when the administration started making changes, people were concerned about — gosh, are we no longer going to have access to certain vaccines?," she says. "But I'm not hearing that anymore."
She says since some of the biggest swings from the White House – including an effort to reduce the number of federally-recommended vaccines for children – were blocked by courts and never took effect, "I'm feeling like a lot of parents are kind of wanting to see what the final result is before they get too concerned."
Still, the potential for confusion is real, she says. Here are the answers to five questions parents might be having about the executive order.
1. Are the same shots still available?
"Yes — as of right now, yes," Shu says. All of the shots in the childhood vaccine schedule backed by pediatricians are still available.
The Trump administration has tried — first through a panel of hand-picked advisors and then unilaterally — to change the list and timing of these vaccines, but has not been successful so far. The new executive order calls for certain things to be researched and reports to be written, but it makes no immediate changes.
All of that highlights the limits of the federal government in this area, says Jen Kates, senior vice president and director of the Global and Public Health Policy Program at the nonpartisan health research organization KFF.
"It's up to states and individual parents," she says. "States are going to make these decisions about school entry and then parents can make their own decisions about timing." In fact, she explains, "in all states but five, parents can opt out of vaccines or they can get a nonmedical exemption.
"So parents actually have quite a bit of choice already, and nothing about this will diminish or expand their choice," she adds.
2. Does this affect which vaccines are covered by insurance?
No, health insurance coverage is unchanged for all vaccines in the American Academy of Pediatrics' vaccine schedule. Nearly all families can receive vaccinations with no copays, including families without health insurance.
In a statement from May, AHIP, the trade association that represents health insurance companies, said that health plans would cover vaccines recommended by the CDC through the end of 2027.
3. Why is this vaccine order happening now?
It's not entirely clear why this executive order is being rolled out now, especially so close to the November midterms elections, since some Republican pollsters have warned vaccine changes are politically hazardous. The timing also intersects with the beginning of the school year.
At the signing, Trump seemed to indicate that his administration was making another move in this area because it matters a lot to him, and because past efforts have been blocked in the courts.
"I believed in this a long time," Trump explained as he signed the executive order Monday. When vaccinating his own children, Trump told reporters, he made extra doctors' appointments to spread out the number of shots they got at one time. "It's inconvenient, it's five stops, but it's something that I think will have a huge impact on autism," he added.
The executive order does not actually address autism and vaccines, but Trump made multiple references to it at the press conference, as did Health Secretary Robert F. Kennedy Jr., a longtime anti-vaccine activist. The links between autism and vaccines have been debunked by many studies.
"There's nothing new," Shu says. "Nothing has changed with the science." She adds that the effort to change the vaccine schedule is "based on misinformation."
4. What's the idea behind spacing out children's shots?
Shu says she does see families who ask about spacing out the vaccine schedule the way Trump describes doing with his own children.
"What I tell parents is that splitting the vaccines has not been studied — putting the vaccines together as scheduled has been proven to be safe and effective," she says. "And sometimes combining vaccines at one visit may help some work better together."
Spacing the vaccines out has downsides, she adds. "Splitting them up leaves a kid more vulnerable to certain infections if they get exposed before they're fully protected by the vaccine, it means more visits to the doctor's office, it means more time off that the parents take — things like that."
5. Could the MMR shot be split into three shots?
Maybe, but it would take a while. The executive order calls for the measles, mumps and rubella vaccine to be divided into three separate shots, but right now separate shots for those vaccines are not available in the U.S. A White House official told reporters on background Monday that the administration would be working with private drugmakers to explore making those available.
"There's no evidence whatsoever that that vaccine should be split, in fact, it raises all kinds of challenges and potential downsides," Kates from KFF says. She points out that one of the complaints raised by Trump is that children get too many shots, yet this change would increase the numbers of shots for the same amount of protection.
Kates adds that Trump's statements during the press conference about the dangers of the MMR shot could have a bigger impact on public health than the policy specifics of splitting up these vaccines. KFF polling shows most parents are supportive of vaccines, Kates says, but even a small group that becomes concerned or confused about vaccines can make a difference when it comes to public health.
"As we can see with the measles outbreak, as soon as you start to bring vaccine coverage down, even a slight amount, that is where you start to see breakthrough [infections] — that's the risk here," she says.
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