Since the 1990s, American children whose parents can’t afford to pay for vaccines have gotten them for free, once an expert committee determined the shots were safe and cost-effective.

The Vaccines for Children program, created in the aftermath of a measles outbreak that hit kids from low-income families disproportionately hard, must cover shots recommended by the Centers for Disease Control and Prevention. The same requirement applies to most private insurance plans, Medicaid and Medicare prescription drug plans.

Last week, Secretary of Health and Human Services Robert F. Kennedy Jr. dismissed all 17 members of the CDC’s Advisory Committee on Immunization Practices, including Dr. Edwin Asturias, a pediatric infectious disease specialist in Aurora.

The committee recommends which shots insurance should cover for specific groups. The CDC director doesn’t have to accept the committee’s recommendations, but usually does.

Kennedy alleged the members had conflicts of interest because many had worked on developing vaccines, and said the replacements would increase public confidence in the committee’s recommendations. Members of the committee already had to declare any conflicts of interest, such as work they’ve done with pharmaceutical companies, and recuse themselves if the group is evaluating a vaccine they worked on or have a financial stake in.

Kennedy also fired staff responsible for vetting new committee members. At least three of the eight replacements he appointed have documented anti-vaccine views, and one, who called himself an “anti-vaxxer,” falsely claimed that COVID-19 shots cause a form of AIDS. Two of the new members acted as paid experts for plaintiffs suing Merck over its human papillomavirus and measles, mumps and rubella vaccines.

Organizations representing medical providers have expressed concerns that the new members will end the recommendations for common vaccines, resulting in insurers no longer covering shots and families losing access.

Asturia, who is on the Colorado School of Public Health faculty and works at Children’s Hospital Colorado but spoke for himself, said he especially worries about kids currently covered by the Vaccines for Children program, which pays to give shots to those who are uninsured, underinsured, eligible for Medicaid or Native American.

In most cases, their parents won’t be able to afford vaccines, which can cost hundreds of dollars, he said.

Insurance companies’ decisions also could create a patchwork, since they could reach different conclusions about whether any savings from not covering vaccines would disappear when they have to pay for increased hospitalizations, Asturias said. While a small percentage of people don’t trust vaccines, the vast majority have shown they want their children to get their shots, he said.

“We know that nine out of 10 children and their families are receiving vaccines,” he said.

States would have the option to require insurance plans they regulate to pay for shots, though any such mandate wouldn’t apply to federally regulated plans.

The U.S. Food and Drug Administration approves vaccines after determining they are safe and effective at either preventing a disease or reducing the odds of severe illness and death. The committee then issues a recommendation about which groups should receive the vaccine, based on safety and cost-effectiveness, Asturias said.

The ACIP issued recommendations on 27 vaccine products, including four that protect against multiple viruses or types of bacteria. Sometimes that recommendation is broad, such as that everyone older than six months should receive a seasonal flu shot. It recommends nine of the vaccines only for people traveling to countries where the diseases are common, or for lab workers who handle those specific viruses.

The dismissed members had expected to discuss moving from a universal recommendation for COVID-19 boosters to one focused on risk, whether to recommend a new antibody drug to protect babies from respiratory syncytial virus and whether to change the chikungunya vaccination recommendation, after some data suggested risks for older people from one of two vaccines on the market, Asturias said.

Federal websites still showed the committee would meet on June 25, but didn’t make clear which of those issues, if any, the new members would discuss.

Normally, the members serve overlapping four-year terms, so everyone doesn’t have to try to get up to speed at the same time, Asturias said. Federal law gives the heads of agencies wide discretion to dismiss appointees, but does allow courts to overturn their decisions if they are “arbitrary and capricious.”

The House Committee on Oversight and Government Reform has asked Kennedy to submit emails related to the dismissals and a detailed explanation for why he removed each member by June 24, according to The New York Times.

The committee has prioritized investigating former President Joe Biden and his family, as well as the origins of the COVID-19 pandemic, so it would be a significant departure if the members faulted one of President Donald Trump’s Cabinet members’ conduct.

Asturias demurred when asked about the new members, saying he urged the public to consider their backgrounds and watch their decisions at upcoming meetings. If they aren’t following the evidence, Americans may have to look to organizations representing physicians for guidance, he said.

Others were more vocal. Dr. Jerome Adams, who was Surgeon General during Trump’s first term, criticized the firings as a thinly veiled attempt to reduce access to vaccines.

Dr. Tom Frieden, president and CEO of Resolve to Save Lives and former director of the CDC, said Kennedy’s actions would politicize the committee and undermine trust in its recommendations.

“We’ll look back at this as a grave mistake that sacrificed decades of scientific rigor, undermined public trust, and opened the door for fringe theories rather than facts,” he said in a statement.