Libby Richards, Purdue University On May 27, 2025, Health and Human Services Secretary Robert F. Kennedy Jr. announced that the Centers for Disease Control and Prevention will no longer include the COVID-19 vaccine on the list of immunizations it recommends for healthy children and pregnant women. The announcement, made in a video posted on the social platform X, comes on the heels of another announcement, made on May 20, in which the Food and Drug Administration revealed that it will approve new versions of the vaccine only for adults 65 years of age and older and for people with one or more risk factors for severe COVID-19 outcomes. The agency will require vaccine manufacturers to conduct clinical trials to demonstrate that the vaccine benefits low-risk groups. The Conversation U.S. asked Libby Richards, a nursing professor from Purdue University involved in public health promotion, to explain what these announcements mean for the general public.

Why are HHS and FDA diverging from past practice?

Currently, getting a yearly COVID-19 vaccine is recommended for everyone ages 6 months and older, regardless of their health risk. In the video announcing the plan to remove the vaccine from the CDC’s recommended immunization schedule for healthy children and healthy pregnant women, Kennedy spoke alongside National Institutes of Health Director Jay Bhattacharya and FDA Commissioner Marty Makary. The trio cited a lack of evidence to support vaccinating healthy children. They did not explain the reason for the change to the vaccine schedule for pregnant people, who have previously been considered at high-risk for severe COVID-19. Similarly, in the FDA announcement made a week prior, Makary and the agency’s head of vaccines, Vinay Prasad, said that public health trends now support limiting vaccines to people at high risk of serious illness instead of a universal COVID-19 vaccination strategy.

Was this a controversial decision or a clear consensus?

Many public health experts and professional health care associations have raised concerns about Kennedy’s latest announcement, saying it contradicts studies showing that COVID-19 vaccination benefits pregnant people and children. The American College of Obstetrics and Gynecology, considered the premier professional organization for that medical specialty, reinforced the importance of COVID-19 vaccination during pregnancy, especially to protect infants after birth. Likewise, the American Academy of Pediatrics pointed to the data on hospitalizations of children with COVID-19 during the 2024-to-2025 respiratory virus season as evidence for the importance of vaccination. Kennedy’s announcement on children and pregnant women comes roughly a month ahead of a planned meeting of the Advisory Committee on Immunization Practices, a panel of vaccine experts that offers guidance to the CDC on vaccine policy. The meeting was set to review guidance for the 2025-to-2026 COVID-19 vaccines. It’s not typical for the CDC to alter its recommendations without input from the committee.

FDA officials Makary and Prasad also strayed from past established vaccine regulatory processes in announcing the FDA’s new stance on recommendations for healthy people under age 65. Usually, the FDA broadly approves a vaccine based on whether it is safe and effective, and decisions on who should be eligible to receive it are left to the CDC, which bases its decision on the advisory committee’s research-based guidance. The advisory committee was expected to recommend a risk-based approach for the COVID-19 vaccine, but it was also expected to recommend allowing low-risk people to get annual COVID-19 vaccines if they want to. The CDC’s and FDA’s new policies on the vaccine will likely make it difficult for healthy people to get the vaccine.

What conditions count as risk factors?

The CDC lists several medical conditions and other factors that increase peoples’ risk for severe COVID-19. These conditions include cancer, diabetes, heart disease, obesity, chronic kidney disease and some lung conditions like COPD and asthma. Pregnancy is also on the list. The article authored by Makary and Prasad describing the FDA’s new stance on the vaccine also contain a lengthy list of risk factors and notes that about 100 million to 200 million people will fall into this category and will thus be eligible to get the vaccine. Pregnancy is included. Reversing the recommendation for vaccinating healthy pregnant women thus contradicts the new framework described by the FDA. Studies have documented that COVID-19 vaccines are safe during pregnancy and may reduce the risk of stillbirth. A study published in May 2025 using data from 26,783 pregnancies found a link between COVID-19 infection before and during pregnancy and an increased risk for spontaneous abortions. Importantly, a 2024 analysis of 120 studies including a total of 168,444 pregnant women with COVID-19 infections did not find enough evidence to suggest the infections are a direct cause of early pregnancy loss. Nonetheless, the authors did state that COVID-19 vaccination remains a crucial preventive measure for pregnant women to reduce the overall risk of serious complications in pregnancy due to infection. Immune changes during pregnancy increase the risk of severe illness from respiratory viruses. Vaccination during pregnancy also provides protection to the fetus that lasts into the first few months of life and is associated with a lower risk of COVID-19 related hospitalization among infants.

The changes to the CDC’s and the FDA’s plan for COVID-19 vaccines also leave out an important group – caregivers and household members of people at high risk of severe illness from infection. This omission leaves high-risk people more vulnerable to exposure to COVID-19 from healthy people they regularly interact with. Multiple countries with risk-based vaccination policies do include this group.

What about vaccines for children?

High-risk children age 6 months and older who have conditions that increase the risk of severe COVID-19 are still eligible for the vaccine. Existing vaccines already on the market will remain available, but it is unclear how long they will stay authorized and how the change in vaccine policy will affect childhood vaccination overall. To date, millions of children have safely received the COVID-19 vaccine. Data on whether children benefit from annual COVD-19 vaccines is less clear. Parents and clinicians make vaccination decisions by weighing potential risks with potential benefits.

Will low-risk people be able to get a COVID-19 shot?

Not automatically. Kennedy’s announcement does not broadly address healthy adults, but under the new FDA framework, healthy adults who wish to receive the fall COVID-19 vaccine will likely face obstacles. Health care providers can administer vaccines “off-label”, but insurance coverage is widely based on FDA recommendations. The new, narrower FDA approval will likely reduce both access to COVID-19 vaccines for the general public and insurance coverage for COVID-19 vaccines. Under the Affordable Care Act, Medicare, Medicaid and private insurance providers are required to fully cover the cost of any vaccine endorsed by the CDC. Kennedy’s announcement will likely limit insurance coverage for COVID-19 vaccination. Overall, the move to focus on individual risks and benefits may overlook broader public health benefits. Communities with higher vaccination rates have fewer opportunities to spread the virus. This is an updated version of an article originally published on May 22, 2025. Libby Richards, Professor of Nursing, Purdue University This article is republished from The Conversation under a Creative Commons license. Read the original article.

Nir Eisikovits, UMass Boston and Daniel J. Feldman, UMass Boston Christopher Pelkey was shot and killed in a road range incident in 2021. On May 8, 2025, at the sentencing hearing for his killer, an AI video reconstruction of Pelkey delivered a victim impact statement. The trial judge reported being deeply moved by this performance and issued the maximum sentence for manslaughter. As part of the ceremonies to mark Israel’s 77th year of independence on April 30, 2025, officials had planned to host a concert featuring four iconic Israeli singers. All four had died years earlier. The plan was to conjure them using AI-generated sound and video. The dead performers were supposed to sing alongside Yardena Arazi, a famous and still very much alive artist. In the end Arazi pulled out, citing the political atmosphere, and the event didn’t happen. In April, the BBC created a deep-fake version of the famous mystery writer Agatha Christie to teach a “maestro course on writing.” Fake Agatha would instruct aspiring murder mystery authors and “inspire” their “writing journey.” The use of artificial intelligence to “reanimate” the dead for a variety of purposes is quickly gaining traction. Over the past few years, we’ve been studying the moral implications of AI at the Center for Applied Ethics at the University of Massachusetts, Boston, and we find these AI reanimations to be morally problematic. Before we address the moral challenges the technology raises, it’s important to distinguish AI reanimations, or deepfakes, from so-called griefbots. Griefbots are chatbots trained on large swaths of data the dead leave behind – social media posts, texts, emails, videos. These chatbots mimic how the departed used to communicate and are meant to make life easier for surviving relations. The deepfakes we are discussing here have other aims; they are meant to promote legal, political and educational causes.

Moral quandaries

The first moral quandary the technology raises has to do with consent: Would the deceased have agreed to do what their likeness is doing? Would the dead Israeli singers have wanted to sing at an Independence ceremony organized by the nation’s current government? Would Pelkey, the road-rage victim, be comfortable with the script his family wrote for his avatar to recite? What would Christie think about her AI double teaching that class? The answers to these questions can only be deduced circumstantially – from examining the kinds of things the dead did and the views they expressed when alive. And one could ask if the answers even matter. If those in charge of the estates agree to the reanimations, isn’t the question settled? After all, such trustees are the legal representatives of the departed. But putting aside the question of consent, a more fundamental question remains. What do these reanimations do to the legacy and reputation of the dead? Doesn’t their reputation depend, to some extent, on the scarcity of appearance, on the fact that the dead can’t show up anymore? Dying can have a salutary effect on the reputation of prominent people; it was good for John F. Kennedy, and it was good for Israeli Prime Minister Yitzhak Rabin. The fifth-century B.C. Athenian leader Pericles understood this well. In his famous Funeral Oration, delivered at the end of the first year of the Peloponnesian War, he asserts that a noble death can elevate one’s reputation and wash away their petty misdeeds. That is because the dead are beyond reach and their mystique grows postmortem. “Even extreme virtue will scarcely win you a reputation equal to” that of the dead, he insists. Do AI reanimations devalue the currency of the dead by forcing them to keep popping up? Do they cheapen and destabilize their reputation by having them comment on events that happened long after their demise? In addition, these AI representations can be a powerful tool to influence audiences for political or legal purposes. Bringing back a popular dead singer to legitimize a political event and reanimating a dead victim to offer testimony are acts intended to sway an audience’s judgment. It’s one thing to channel a Churchill or a Roosevelt during a political speech by quoting them or even trying to sound like them. It’s another thing to have “them” speak alongside you. The potential of harnessing nostalgia is supercharged by this technology. Imagine, for example, what the Soviets, who literally worshipped Lenin’s dead body, would have done with a deep fake of their old icon.

Good intentions

You could argue that because these reanimations are uniquely engaging, they can be used for virtuous purposes. Consider a reanimated Martin Luther King Jr., speaking to our currently polarized and divided nation, urging moderation and unity. Wouldn’t that be grand? Or what about a reanimated Mordechai Anielewicz, the commander of the Warsaw Ghetto uprising, speaking at the trial of a Holocaust denier like David Irving? But do we know what MLK would have thought about our current political divisions? Do we know what Anielewicz would have thought about restrictions on pernicious speech? Does bravely campaigning for civil rights mean we should call upon the digital ghost of King to comment on the impact of populism? Does fearlessly fighting the Nazis mean we should dredge up the AI shadow of an old hero to comment on free speech in the digital age?

Even if the political projects these AI avatars served were consistent with the deceased’s views, the problem of manipulation – of using the psychological power of deepfakes to appeal to emotions – remains. But what about enlisting AI Agatha Christie to teach a writing class? Deep fakes may indeed have salutary uses in educational settings. The likeness of Christie could make students more enthusiastic about writing. Fake Aristotle could improve the chances that students engage with his austere Nicomachean Ethics. AI Einstein could help those who want to study physics get their heads around general relativity. But producing these fakes comes with a great deal of responsibility. After all, given how engaging they can be, it’s possible that the interactions with these representations will be all that students pay attention to, rather than serving as a gateway to exploring the subject further.

Living on in the living

In a poem written in memory of W.B. Yeats, W.H. Auden tells us that, after the poet’s death, Yeats “became his admirers.” His memory was now “scattered among a hundred cities,” and his work subject to endless interpretation: “the words of a dead man are modified in the guts of the living.” The dead live on in the many ways we reinterpret their words and works. Auden did that to Yeats, and we’re doing it to Auden right here. That’s how people stay in touch with those who are gone. In the end, we believe that using technological prowess to concretely bring them back disrespects them and, perhaps more importantly, is an act of disrespect to ourselves – to our capacity to abstract, think and imagine. Nir Eisikovits, Professor of Philosophy and Director, Applied Ethics Center, UMass Boston and Daniel J. Feldman, Senior Research Fellow, Applied Ethics Center, UMass Boston This article is republished from The Conversation under a Creative Commons license. Read the original article.

Zachary W. Schulz, Auburn University A few years ago, a student in my history of public health course asked why her mother couldn’t afford insulin without insurance, despite having a full-time job. I told her what I’ve come to believe: The U.S. health care system was deliberately built this way. People often hear that health care in America is dysfunctional – too expensive, too complex and too inequitable. But dysfunction implies failure. What if the real problem is that the system is functioning exactly as it was designed to? Understanding this legacy is key to explaining not only why reform has failed repeatedly, but why change remains so difficult. I am a historian of public health with experience researching oral health access and health care disparities in the Deep South. My work focuses on how historical policy choices continue to shape the systems we rely on today. By tracing the roots of today’s system and all its problems, it’s easier to understand why American health care looks the way it does and what it will take to reform it into a system that provides high-quality, affordable care for all. Only by confronting how profit, politics and prejudice have shaped the current system can Americans imagine and demand something different.

Decades of compromise

My research and that of many others show that today’s high costs, deep inequities and fragmented care are predictable features developed from decades of policy choices that prioritized profit over people, entrenched racial and regional hierarchies, and treated health care as a commodity rather than a public good. Over the past century, U.S. health care developed not from a shared vision of universal care, but from compromises that prioritized private markets, protected racial hierarchies and elevated individual responsibility over collective well-being. Employer-based insurance emerged in the 1940s, not from a commitment to worker health but from a tax policy workaround during wartime wage freezes. The federal government allowed employers to offer health benefits tax-free, incentivizing coverage while sidestepping nationalized care. This decision bound health access to employment status, a structure that is still dominant today. In contrast, many other countries with employer-provided insurance pair it with robust public options, ensuring that access is not tied solely to a job. In 1965, Medicare and Medicaid programs greatly expanded public health infrastructure. Unfortunately, they also reinforced and deepened existing inequalities. Medicare, a federally administered program for people over 64, primarily benefited wealthier Americans who had access to stable, formal employment and employer-based insurance during their working years. Medicaid, designed by Congress as a joint federal-state program, is aimed at the poor, including many people with disabilities. The combination of federal and state oversight resulted in 50 different programs with widely variable eligibility, coverage and quality.

Southern lawmakers, in particular, fought for this decentralization. Fearing federal oversight of public health spending and civil rights enforcement, they sought to maintain control over who received benefits. Historians have shown that these efforts were primarily designed to restrict access to health care benefits along racial lines during the Jim Crow period of time.

Bloated bureaucracies, ‘creeping socialism’

Today, that legacy is painfully visible. States that chose not to expand Medicaid under the Affordable Care Act are overwhelmingly located in the South and include several with large Black populations. Nearly 1 in 4 uninsured Black adults are uninsured because they fall into the coverage gap – unable to access affordable health insurance – they earn too much to qualify for Medicaid but not enough to receive subsidies through the Affordable Care Act’s marketplace. The system’s architecture also discourages care aimed at prevention. Because Medicaid’s scope is limited and inconsistent, preventive care screenings, dental cleanings and chronic disease management often fall through the cracks. That leads to costlier, later-stage care that further burdens hospitals and patients alike. Meanwhile, cultural attitudes around concepts like “rugged individualism” and “freedom of choice” have long been deployed to resist public solutions. In the postwar decades, while European nations built national health care systems, the U.S. reinforced a market-driven approach. Publicly funded systems were increasingly portrayed by American politicians and industry leaders as threats to individual freedom – often dismissed as “socialized medicine” or signs of creeping socialism. In 1961, for example, Ronald Reagan recorded a 10-minute LP titled “Ronald Reagan Speaks Out Against Socialized Medicine,” which was distributed by the American Medical Association as part of a national effort to block Medicare. The health care system’s administrative complexity ballooned beginning in the 1960s, driven by the rise of state-run Medicaid programs, private insurers and increasingly fragmented billing systems. Patients were expected to navigate opaque billing codes, networks and formularies, all while trying to treat, manage and prevent illness. In my view, and that of other scholars, this isn’t accidental but rather a form of profitable confusion built into the system to benefit insurers and intermediaries.

Coverage gaps, chronic disinvestment

Even well-meaning reforms have been built atop this structure. The Affordable Care Act, passed in 2010, expanded access to health insurance but preserved many of the system’s underlying inequities. And by subsidizing private insurers rather than creating a public option, the law reinforced the central role of private companies in the health care system. The public option – a government-run insurance plan intended to compete with private insurers and expand coverage – was ultimately stripped from the Affordable Care Act during negotiations due to political opposition from both Republicans and moderate Democrats. When the U.S. Supreme Court made it optional in 2012 for states to offer expanded Medicaid coverage to low-income adults earning up to 138% of the federal poverty level, it amplified the very inequalities that the ACA sought to reduce. These decisions have consequences. In states like Alabama, an estimated 220,000 adults remain uninsured due to the Medicaid coverage gap – the most recent year for which reliable data is available – highlighting the ongoing impact of the state’s refusal to expand Medicaid. In addition, rural hospitals have closed, patients forgo care, and entire counties lack practicing OB/GYNs or dentists. And when people do get care – especially in states where many remain uninsured – they can amass medical debt that can upend their lives. All of this is compounded by chronic disinvestment in public health. Federal funding for emergency preparedness has declined for years, and local health departments are underfunded and understaffed. The COVID-19 pandemic revealed just how brittle the infrastructure is – especially in low-income and rural communities, where overwhelmed clinics, delayed testing, limited hospital capacity, and higher mortality rates exposed the deadly consequences of neglect.

A system by design

Change is hard not because reformers haven’t tried before, but because the system serves the very interests it was designed to serve. Insurers profit from obscurity – networks that shift, formularies that confuse, billing codes that few can decipher. Providers profit from a fee-for-service model that rewards quantity over quality, procedure over prevention. Politicians reap campaign contributions and avoid blame through delegation, diffusion and plausible deniability. This is not an accidental web of dysfunction. It is a system that transforms complexity into capital, bureaucracy into barriers. Patients – especially the uninsured and underinsured – are left to make impossible choices: delay treatment or take on debt, ration medication or skip checkups, trust the health care system or go without. Meanwhile, I believe the rhetoric of choice and freedom disguises how constrained most people’s options really are. Other countries show us that alternatives are possible. Systems in Germany, France and Canada vary widely in structure, but all prioritize universal access and transparency. Understanding what the U.S. health care system is designed to do – rather than assuming it is failing unintentionally – is a necessary first step toward considering meaningful change. Zachary W. Schulz, Senior Lecturer of History, Auburn University This article is republished from The Conversation under a Creative Commons license. Read the original article.