Can the Midterms Save Vaccines? Don't Count on It.

— Even if Congress is flipped, public health faces longer-term threats at federal and state levels

If the mid-October polls are accurate, the public health community will have many more friends when the new Congress convenes on January 3, 2027. However, even an outcome that brings more pro-vaccine members to Congress will still leave vaccines facing long-term existential threats at both the federal and state levels through regulatory and legislative proposals and actions.

Heavy lifting from pro-vaccine policymakers and advocates will be essential over the next 2 years, but this need will likely stretch into 2029 and beyond.

Vaccines in 2026: A Mix of Progress and Slippage

Throughout 2025, President Trump and HHS Secretary Robert F. Kennedy Jr.'s anti-vaccine policies kept expanding. This created an opportunity to make vaccine advocacy a viable electoral issue in 2026. Accordingly, we urged the public health and medical communitiesopens in a new tab or window to embrace a long-term grassroots, pro-vaccine movement with a narrative that could move voters and votes in the midterms.

Much needed to be overcome to make a quick impact: public health concerns rarely have the breadth, immediacy, or saliency to affect elections; and every election is its own story, most often shaped by organic public concerns (often national concerns, like affordability) rather than by third-party campaigns.

Despite those barriers, vaccine advocates succeeded in 2026 by increasing awareness of the harms anti-vaccine policies pose to individuals, communities, and the economy, and by creating informal coalitions to share information and align activities, consistent with what we urged.

Those collaborative groups coordinated opposition to federal and state actions targeting vaccine use, including a lawsuit challengingopens in a new tab or window the reshaping of the Advisory Committee on Immunization Practices (ACIP) and the associated reductionsopens in a new tab or window in recommendations for routine vaccines. (In parallel with this, many medical societies put forth their own recommendationsopens in a new tab or window for routine vaccines that essentially mirrored the pre-2025 ACIP's guidance.) Those collaborating groups also coordinated responses to changes to HHS and FDA vaccine advisory groups, updates to respiratory vaccine recommendationsopens in a new tab or window, and to state initiatives to expand school vaccine exceptionsopens in a new tab or window.

Meanwhile, we've also seen slippage in the pro-vaccine movement in 2026. For example, our December 2025 op-ed didn't anticipate certain actions that kept vaccine policy issues more local and fragmented in 2026. After the ACIP-related controversies, and reportedly at the White House's behest, Kennedy temporarily pursued less direct anti-vaccine policies. While he did not change his overall position or his aggressive pursuit of those policies, Kennedy focused more on vaccine topics less likelyopens in a new tab or window to become major midterm election issues, such as increased vaccine injury research at NIH.

Many other factors contributed to vaccine policy not becoming an even bigger national concern during the 2026 elections, notably the national focus on the two wars driving up energy and food prices; a mild 2025-2026 flu season; a shameful and muted federal response to the number of measles outbreaks, cases, and deaths not seen in decades; and the political splintering of Make America Healthy Again -- a movement that we believe could ultimately morph into an ally for vaccines that lessen or prevent chronic disease, such as heart disease and cancers.

Vaccines 2027: Expanded Congressional Support Offset by Aggressive Executive Branch Action

As noted, vaccine advocates are likely to be better represented in Congress next year, even if Democrats take charge of the House (near certain) but fall short in the Senate (a 50/50 likelihoodopens in a new tab or window). While this will undoubtedly help, it won't be enough. Vaccine advocates need to prepare for a difficult 2027.

In similar situations in the past, increased representation in Congress and control of at least one legislative body would be enough to provide significant protection for a cause like vaccines and public health.

This time will be different. This is due to Trump's commitment to governing based on an approach that boldly ignores congressional authorities and federal court orders, in tandem with Kennedy's decades-long commitment to anti-vaccine policies.

Cabinet secretaries often stay about 2 years and leave after the midterm elections. Sometimes this is voluntary, but other times it reflects the president's desire for new leadership. In this case, there is no indication that Kennedy plans to leave and Trump has gone out of his way to show support for Kennedyopens in a new tab or window.

Once the midterm elections are over, we expect Kennedy to pursue a host of new anti-vaccine policies and revive many that were previously blocked. The White House will not want to hold him back -- after all they have faced the voters for the last time (if only indirectly this year).

Meanwhile, Trump supports a conservative legal theoryopens in a new tab or window (unitary executive authority) that holds that the president controls the entire executive branch and can, through executive orders, run it independently of checks and balances. He has encroached on areas that have constitutionally and historically been Congress's domain, such as appropriations, tariffs, and the power to declare war. In addition, the administration often argues it is not bound by court rulingsopens in a new tab or window.

The Future of Vaccines

After the midterm elections, we anticipate Trump will see himself as the sole arbiter of America's needs and back it up with his veto pen, wide-ranging executive orders, non-cooperation with congressional oversight, and ignoring, slow-walking, or constantly re-litigating judicial rulings. Not every issue will get the full treatment, but because of Kennedy's intense interest, vaccines likely will.

This has never happened this way before. No playbook exists for how vaccine advocates can stop policies they oppose when oversight is neutered, laws overridden, and the judiciary ignored.

So, yes, 2027 will be a tough year for vaccine advocates. Substantial losses could occur.

Only strong, active advocacy from the health community and other local and national leaders will keep public health and vaccine protections intact and not felled like the trees in East Potomac Parkopens in a new tab or window.