Good morning. Today's newsletter is 1,180 words or a 4.5-minute read.

Health Secretary Robert F. Kennedy Jr.'s push to reshape vaccine policy will hit a crescendo today, when his handpicked advisory panel is expected to consider limiting the availability of MMR, hepatitis B and COVID-19 shots.

Why it matters: The Advisory Committee on Immunization Practices (ACIP) traditionally operates on scientific consensus and makes recommendations to the CDC director.

• But Kennedy's summertime purge of the committee — and the lack of a full-time political leader at the agency — has many in the scientific and health community convinced that the new appointees will rubber-stamp more limits on who can get routine shots.

What they're saying: "ACIP has quite literally been the north star of America's approach to vaccination for decades," Jason Schwartz, a vaccine policy expert and associate professor at the Yale School of Public Health, told Axios.

• "That's why it was so often the focus of criticism by critics of vaccines, and I think that's why we're seeing such attention on the part of the administration."

Friction point: Yesterday, the Democratic governors of Oregon, Washington, California and Hawai'i released a set of immunization guidelines for their own states that, among other things, appear to eliminate the need for a prescription to get the 2025-2026 COVID-19 booster.

• And the health insurance trade group AHIP said its members would continue to cover immunizations the advisory committee recommended as of Sept. 1, including updated COVID-19 and flu shots, at no cost to patients through the end of next year.

Inside the room: The agenda calls for discussions over two days on the hepatitis B vaccine, the MMRV vaccine and COVID boosters, as well as the safety review of COVID vaccines already delivered.

• The Washington Post reported Trump administration officials will present data from a federal database of adverse events and side effects linking COVID vaccines to the deaths of 25 children, even though the database isn't designed to show causality.
• Other topics on the agenda include reports of seizures following MMRV vaccine and doses of hepatitis B vaccine given at birth.

Read more

Former CDC director Susan Monarez got her turn yesterday to tell the Senate health committee about the events that led up to her firing in August after less than a month on the job.

• She recalled how she was forced out after refusing to "pre-approve" vaccine recommendations from Kennedy's handpicked advisers and to fire career CDC scientists.
• But she also provided a window into the ongoing turmoil at the public health agency.

Here's what stood out:

Vaccine recommendations could be further weakened

Monarez raised the alarm that major changes to the childhood vaccine schedule are imminent.

• She said Kennedy told her in an August meeting that changes to the schedule are coming this month, though the substance of the changes is not clear.
• "He did say that he had spoken to the president, he spoke to the president every day about changing the childhood vaccine schedule," Monarez testified.
• An HHS spokesperson responded that any changes would be based on the "latest available science" and only come after a recommendation from the CDC advisory panel.

Cassidy pushes back on hepatitis B vaccine changes

Health committee Chair Bill Cassidy (R-La.), a physician who specialized in gastroenterology and liver diseases, spoke about his experience treating patients with hepatitis and warned against a potential weakening of the recommendation for newborns to receive the hepatitis B vaccine.

• Such a change could be made at the CDC advisory committee meeting tomorrow and Friday. One option would be delaying the shots from birth to age 4.
• "This was my practice for 20 years," Cassidy said. "There are people who would otherwise be dead" if not for hepatitis B vaccination, he added, noting cases had plummeted since the recommendation for newborns began in the early 1990s.
• Cassidy did not openly criticize Kennedy and said later Kennedy needs to appear before the committee to respond.

Keep reading

The CDC is no longer allowing remote work for employees with disabilities or those with temporary health issues, including those who've requested to work from home since the Aug. 8 attack on the agency's Atlanta headquarters.

Why it matters: The legality of such a move is questionable, and it may violate a law that requires the government to offer reasonable accommodations to those with disabilities.

• It's also angered and confused CDC staffers, who say they already feel under siege.

Zoom in: An agency-wide notice sent yesterday morning and viewed by Axios says that HHS has updated its policy to no longer include teleworking or long-term teleworking as a reasonable accommodation.

• The email says the policy took effect Aug. 13, just five days after the shooting at CDC.

It's not yet clear whether the policy is permanent or how it's being enforced. Complicating matters, the officials who oversee reasonable accommodation requests were fired in April as part of a sweeping reduction in force, employees say.

Between the lines: Many CDC workers feel unsafe coming into work since last month's shooting, which they say was stoked in part by Kennedy's anti-vaccine rhetoric.

• Bullet holes in windows from some of the hundreds of rounds that were fired are currently covered up with tape, CDC employees say.
• "They've sent emails about what to expect when you're on campus — like, here are the visual things that you might see when you get there. And also, as a reminder, don't lean on the windows," one CDC scientist, speaking anonymously due to concerns about retaliation, tells Axios.

More here

Distributors work around the clock to deliver medicines to providers, pharmacies and other sites of care.

Here’s how: Dedicated people across the industry are constantly adapting and leveraging new innovations to meet the needs of patients and ensure a safe and efficient supply chain.

Learn more.

About 14% of the insured population has been diagnosed with anxiety by a health care professional, driving up health care spending and limiting productivity, according to a new analysis of claims data by Cigna.

The big picture: Anxiety is particularly pronounced among Gen Z and millennials — groups that are rapidly becoming the majority of the workforce.

• Despite the availability of behavioral health resources, many in these age groups aren't fully utilizing the benefits offered to them, the study found.

By the numbers: People diagnosed with anxiety account for $13.9 billion in medical, behavioral and pharmacy expenses.

• There was a 20% increase in the prevalence of diagnosed mental and behavioral health conditions between 2020 and 2024.
• Nearly a third (30%) of workers report having anxiety, whether self-identified or diagnosed by a health care professional.

Between the lines: While workers with anxiety are just as likely to receive merit increases or promotions and often have a strong willingness to take on added work, they experience lower self-confidence than their peers.

Read the study