Category: The Conversation

Source: The Conversation – USA (2) – By Allie McCreary, Assistant Professor of Parks and Recreation, Auburn University

Visiting America’s national parks is a treasured public pastime. The wetlands of Congaree in South Carolina, the depths of the Grand Canyon in Arizona and the vistas provided by peaks in Yosemite in California are iconic American experiences for residents and for people who travel from other countries to vacation.

There are lots of benefits of visiting national parks, or parks in general. Spending time in nature is good for people’s mental health. Moving in the outdoors – walking, biking, running, paddling – benefits people’s physical health. Sharing experiences with others helps build social connections with old friends or newfound ones. Visitors also learn about ecosystems and cultural history, developing their own relationship to the landscape.

National park visitation is growing, with record-high visitor numbers in 2024 across the entire 398-property system, as well as at the 63 formally designated national parks. And there has been a general trend of people gravitating to Instagram-popular parks, and even specific spots within popular parks.

Reductions in federal funding and staffing at national parks means visitors may see longer lines to enter parks or popular locations within them, fewer visitor services and educational programs, and fewer rangers to ask for advice or assistance.

As scholars of parks and recreation, we know crowded conditions make it harder to enjoy national parks. But we also know that if you plan carefully, you can create a great experience.

What gets in the way of fun?

In general, research identifies three main barriers to recreational fun.

One is how confident people are in their own physical abilities and how safe they feel in the park. For example, someone may want to go kayaking in Florida’s Everglades or Minnesota’s Voyageurs National Park but doesn’t know where to rent a boat, where to put it in the water, or which stretches of water are best for a beginner.

Another is the presence – or absence – of people to enjoy the space with, or family obligations or relationships that might preclude them from an activity. Culture can also play a role in where people visit and what they do there. For instance, a national park may be a source of escape where individuals seek autonomy and independence. For others, a national park visit can be a focal point for social gatherings and a time to reconnect with family and friends.

There are also external factors, like how much free time a person has for recreation and how easy it is to get to a national park from their home. Someone may live a short drive from a national park but not visit simply because they do not know what they can do there, or how to have a positive experience.

More recently, research has also identified environmental barriers outside visitors’ control. Thin ice or lack of snow prevents many winter activities in Colorado’s Rocky Mountain National Park and Maine’s Acadia National Park, just as excessive heat can decrease the attractiveness of summer recreation in parks like the Everglades or California’s Death Valley. Extreme weather events such as inland flooding and coastal hurricanes can block roads and damage parks, posing both physical and logistical barriers in parks such as Cape Lookout National Seashore in North Carolina.

Wildlife habits also affect visitors, who may flock to an area where they can see wildlife. Or they may avoid – or may be restricted from – areas with dangerous wildlife.

Adapting to find enjoyment anyway

If the national park places you want to visit seem too busy, think about your options. You could change your travel dates to a less busy time. People who want to visit Yellowstone in Wyoming, Idaho and Montana could find campground reservations unavailable for some weeks but plentiful for other weeks – or they could choose to stay in a local hotel instead of camping.

You could try a different park or activity. For example, an angler who typically visits Great Smoky Mountains National Park in North Carolina and Tennessee to fish for trout may find that some streams are warming and no longer support this activity. They might go fishing elsewhere or stay in the Smokies and bird-watch, hike or read by a stream.

If you really want to visit during a busy time, you can also simply change your expectations, like not expecting Old Faithful to be a quiet place with only a few visitors.

Park personnel often seek to manage visitor numbers to protect the park from too much traffic, but also so everyone who visits can enjoy the experience. For example, implementing reservations for Acadia’s Cadillac Mountain at sunrise means at least some people get a relatively serene experience, as opposed to lots of people having an overcrowded experience.

Park staff also design park amenities so roads, boat ramps, trailheads and parking are in useful locations that work well for the number of visitors expected. And park workers provide advance information for visitors, in brochures and on websites, charge fees for entry, conduct tours or other programs at the location – and ticket or arrest people who are in places or doing activities they’re not supposed to – to reduce the effects of overcrowding.

Planning is key

We have found that the most effective way for people to have the park experiences they want, and enjoy them as much as they hope, is to plan ahead.

Planning can include looking at parks’ websites for ideas and considering the best time to visit – both for your own schedule and what you want to do.

Understanding the weather and climate of the region will help you determine what to bring, but also what conditions will be like if you’re hiking, paddling or driving.

Advance preparation definitely includes finding lodging – and making reservations whenever possible. If reservations aren’t possible, see whether you can increase your chances of finding a place to sleep when you arrive by choosing lesser-visited parts of the park or identifying nearby backup options, such as state parks and private campgrounds, that might provide a break from the crowds.

And you can make sure you’re prepared for whatever you’re going to do, whether it’s getting used to walking long distances before a big hike or learning about local flora and fauna before you arrive.

Thinking ahead also means you can share your itinerary with friends and family – either as invitations to join you or for periodic safety check-ins.

It is also helpful to talk to park personnel. Park staff will have great insights into hidden gems that might be slightly off the beaten path but away from the crowds and able to provide a unique visitor experience. Rangers or other staff can help you determine the best choices for settings and activities that match your abilities, interests, time and needs.

And finally, don’t forget to be considerate of other visitors. Have patience in the parking lots, visitor centers, trailheads and lookout points. Others in the park seek the same awe-inspiring views and heart-pumping recreation activities as you. In many cases, it’s not the number of people but the attitudes and behaviors of those people that can make a place either feel crowded or like a community of like-minded outdoor enthusiasts.

Allie McCreary receives funding from the Public Lands Service Coalition and New Frontiers in Research Fund (Government of Canada).

Michael Brunson is affiliated with The Appalachian Trail Conservancy and the National Association for Interpretation .

– ref. As National Park System visitor numbers hit record highs, here’s how visitors can adapt for a better experience – https://theconversation.com/as-national-park-system-visitor-numbers-hit-record-highs-heres-how-visitors-can-adapt-for-a-better-experience-262407

Source: The Conversation – USA (2) – By H. Sami Karaca, Professor of Business Analytics, Questrom School of Business, Boston University

Is the Trump administration trying to reshape American capitalism? Recent moves by Washington, such as taking a 10% share of semiconductor maker Intel, point to a shift in that direction. For decades, Washington has supported free-market capitalism. Today, the government appears to be supporting a new direction – state-directed capitalism.

As a professor at the Questrom School of Business who studies different economic systems, I find this reversal striking. My research is supported by the Ravi K. Mehrotra Institute, which is trying to understand how business, markets and society interact. My previous research – finding, for example, that U.S. news coverage of capitalism was far more negative in the 1940s than it is now – suggests capitalism isn’t in retreat but is rather evolving.

In what direction is the Trump administration pushing it?

Types of capitalism

While many people bandy around the term “capitalism,” it actually comes in many different forms. The most basic definition of capitalism is when the means of production – such as factories, farms and offices – are owned by private individuals.

Capitalism is driven by profit. Some of the earliest descriptions of the profit motive that drives the whole system come from Adam Smith. As he wrote in 1776, “It is not from the benevolence of the butcher, the brewer or the baker that we expect our dinner, but from their regard to their own interest.”

Who gets the profits and who controls the means of production determine the specific forms of capitalism. While there are many types, I want to focus on three of the most important.

Free-market capitalism, also called laissez-faire capitalism, is when the government takes a hands-off approach to the economy. The U.S. after the Civil War is a good example of free-market capitalism. During the late 1800s, the federal government imposed few regulations on businesses.

State-guided capitalism is when the government chooses industries or companies to support. Favored sectors are given money and face looser regulations than nonfavored sectors. China today is an example of state-guided capitalism, where the state provides support for industries such as shipbuilding, steel and AI.

Oligarchic capitalism is when a very small part of the population owns key industries and controls the economy. Russia today is an example of this type of capitalism.

Each form of capitalism has its strengths and weaknesses. For example, free-market capitalism provides the most incentives to grow the economy, but the lack of rules often leads businesses to run roughshod over consumers. U.S. historians describe the late 1800s as the era of robber barons.

State-guided capitalism can dramatically boost the output of favored industries. However, if the government invests in the wrong industries, huge amounts of money can be wasted propping up dying firms.

Oligarchic capitalism can rapidly invest in new areas and shift resources, but the profits enrich only a tiny elite.

Recent changes

The U.S. currently appears to be operating under a hybrid model of capitalism, blending free-market principles with elements of state capitalism.

One of the most recent changes is the Trump administration’s decision to take a 10% stake in Intel. Congress passed the multibillion-dollar CHIPS and Science Act in 2022 to bolster U.S. computer chipmakers. Intel is slated to receive US$11.1 billion in grants from the program and other government funding. The current administration has converted that public support into a 10% ownership of the semiconductor maker.

Intel isn’t alone. The government has recently become a shareholder in other companies it views as strategically important – a trend that seems likely to continue and possibly result in the creation of a “sovereign wealth fund.” In July 2025, the Department of Defense agreed to buy $400 million of convertible preferred stock in MP Materials. MP Materials is the only U.S. rare-earth minerals mine with integrated production capacity. The company said the Department of Defense would be positioned to become its largest shareholder.

The government is also requiring a share of revenue from large computer chip manufacturers. Nvidia and AMD will have to remit 15% of revenue from certain chip sales to China as a condition for export licenses.

Why the US change is important

The CHIPS and Science Act has already funneled billions into U.S. semiconductor manufacturing via grants, tax credits and R&D support. MP Materials and Intel could serve as pilot models for further strategic intervention. However, the U.S. government spends trillions each year, and the amounts invested in American industries and companies represent only a small percentage of total spending.

While the CHIPS and Science Act was passed in 2022 under the Biden administration, the implementation relied on traditional tools of industrial policy such as grants, tax credits and milestone-based funding. In contrast, the Trump administration has converted these grants into equity arrangements, with officials stating the government should get a return on its investment.

This shift from an incentive-based approach to a direct ownership model represents one of the most fascinating experiments in modern American capitalism. The real question is what happens if – or when – this strategy expands. The government could become more involved in energy, biotech and AI, or any place where markets show signs of lagging or supply chains are geopolitically fragile.

The U.S. isn’t rejecting capitalism but recalibrating its boundaries. The next few years will show exactly how Washington’s interventions will reshape U.S. capitalism.

H. Sami Karaca receives funding from the Ravi K. Mehrotra Institute.

– ref. American capitalism is being remade by state power – https://theconversation.com/american-capitalism-is-being-remade-by-state-power-263881

Source: The Conversation – USA (2) – By Jody L. Herman, Senior Scholar of Public Policy at the Williams Institute, University of California, Los Angeles

Researchers have traditionally had a difficult time tracking the number of Americans who identify as transgender.

But over the past decade, our work has become easier, largely thanks to federal data. In 2014, for the first time, the federal government included a question on transgender identity in the Centers for Disease Control and Prevention’s Behavior Risk Factor Surveillance System. It subsequently added gender identity questions to other surveys, like the National Crime Victimization Survey. Since 2016, we’ve been able to use federal datasets to estimate the number of people who identify as transgender at the national and state levels.

Our recently published analysis suggests that 2.1 million U.S. adults identify as transgender. In our prior study, published in 2022, we found that 1.3 million U.S. adults identified this way. In our new report, we also found that 724,000 youth age 13 to 17 identified as transgender.

To arrive at these estimates, we drew from the CDC’s Youth Risk Behavior Survey and Behavior Risk Factor Surveillance System, which provide the most comprehensive data on the gender identity of Americans. Though these datasets are the best available to make these estimates, we lack state-level data in certain cases. So we used a statistical technique called multilevel regression and poststratification to fill in those gaps.

This information is important. It allows policymakers, educators, judges, the media and others to understand the size and characteristics of this population, as well as who will be affected by public policies, such as nondiscrimination laws that aim to protect transgender people or bans on transgender people’s use of public bathrooms. The U.S. Supreme Court has even cited our estimates in decisions that impact transgender people.

But our work is about to become a lot harder, if not impossible.

At the directive of the Trump administration, federal surveys will no longer collect data about gender identity. Questions that aim to identify transgender respondents will be removed, while binary sex questions with only “male” or “female” response options will remain.

Though data sources are being erased, the transgender population will not be. And yet it will likely be at least a decade before we can publish updated figures on the estimated number of people living in the U.S. who identify as transgender.

Age group differences persist

But first, let’s highlight what the new report reveals.

One consistent pattern across our reports from 2017, 2022 and 2025 is that younger people are more likely to identify as transgender than older adults.

In our new report, however, we were able to see significant differences among different age groups of adults for the first time.

Those 18 to 34 are now significantly more likely to identify as transgender than those 65 and older, and those 18 to 24 are significantly more likely to identify as transgender than those 35 to 64.

When considering population changes over time, our estimates for the youngest age group – those 13 to 17 – have utilized different data sources and methodologies. Therefore, we can’t make direct comparisons across years. Among adults overall, we haven’t seen any significant changes over the past decade or so.

However, our estimate for the youngest adult age group – those 18 to 24 – is now significantly higher. Using 2014-15 data, we estimated that 0.7% of U.S. adults aged 18 to 24, or 205,850 people, identified as transgender. The data we analyzed from 2021-23 puts that figure at 2.7%, or 827,200 Americans.

This uptick doesn’t support the idea that there is a sudden, rapid growth in the transgender youth population, however. In fact, our findings are consistent with the idea that acceptance of gender and sexuality is generational and shaped by your social surroundings.

These generational differences likely impact whether someone will disclose their transgender identity on a survey. Our own analysis of CDC data found that young people are more likely than older adults to answer questions about their gender identity. This also means the real percentage of older adults who identify as transgender may be higher.

As younger transgender people grow older, we expect observed differences between age groups to diminish over time.

Disappearing data sources

More research is required to determine the reasons for this growth among young adults identifying as transgender. Yet future efforts to better identify and understand transgender population trends will likely be delayed for the foreseeable future.

Should gender identity data collection be reinstituted under a new presidential administration in 2029, federal surveys will need to be updated and administered. Once data collection resumes, three years of new data are required before we can update our estimates.

While we and other researchers will look to other data sources in the interim, there’s nothing that can fully replace federal data sources.

In the end, no amount of data suppression can erase the reality on the ground. Millions of transgender youth and adults will continue to live in communities across the U.S. – in cities and small towns, in red states and blue states. They’ll continue to enroll in schools, get hired for jobs and navigate health care systems.

This population will not vanish simply because some of those in power wish it would. But in order for us to continue to shed light on the characteristics and needs of the transgender population – whether it’s assessing impacts of gender-affirming care bans to changes in U.S. passport gender marker policies – we’ll need these questions to be added back on federal surveys.

Andrew Ryan Flores receives funding from The Williams Institute at the UCLA School of Law to conduct research that fulfills the Institute’s mission of independent research. He is affiliated with American University, the Public Religion Research Institute, and the World Bank.

Jody L. Herman does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

– ref. We’ve been tracking the number of Americans who identify as transgender – soon, there will be no reliable way to measure them – https://theconversation.com/weve-been-tracking-the-number-of-americans-who-identify-as-transgender-soon-there-will-be-no-reliable-way-to-measure-them-263599

Source: The Conversation – USA (3) – By Almut Winterstein, Distinguished Professor of Pharmaceutical Outcomes & Policy, University of Florida

A panel convened in July 2025 by the Food and Drug Administration sparked controversy by casting doubt about the safety of commonly used antidepressants during pregnancy. But it also raised the broader issue of how little is known about the safety of many medications used in pregnancy, considering the implications for both mother and child – and how understudied this topic is.

In the U.S., the average pregnant patient takes four prescription medications, and more than 9 in 10 patients take at least one. But most drugs lack conclusive evidence about their safety during pregnancy. About 1 in 5 women uses a medication during pregnancy that has some preliminary evidence that it could cause harm but for which conclusive studies are missing.

We are researchers in maternal and child health who evaluate the safety of medications during pregnancy. In our work, we identify medications that might raise the risk for birth defects or pregnancy loss and compare the safety of different treatments.

While progress has been slow, researchers and federal agencies have built monitoring systems, databases and tools to accelerate our understanding of medication safety. However, these efforts are now at risk due to ongoing cuts to medical research funding – and with them, so is the knowledge base for determining whether sticking with a therapy or discontinuing it offers the safest choice for both mother and child.

How pregnant women got sidelined

One big reason why so little is known about the effects of medications during pregnancy stretches back more than half a century. In the 1960s, a drug called thalidomide that was widely prescribed to treat morning sickness in pregnant women caused severe birth defects in over 10,000 children around the world. In response, in 1977 the FDA recommended excluding women of childbearing age from participating in early stage clinical trials testing new medications.

Ethically, there is long-standing tension between concerns about fetal harm and maternal needs. Legal liability and added complexities when conducting studies in pregnant women serve as additional barriers for drug manufacturers.

When drugs are approved, studies about whether they might cause birth defects are typically done only in animals, and they often don’t translate well to humans. So when a new medication comes on the market, nothing is known about how it affects people during pregnancy. Even if animal studies or the medication’s mode of action raised concerns, the drug can still be approved, though companies may be required to conduct studies observing its effects when taken during pregnancy.

Cause and effect

Of 290 drugs approved by the FDA between 2010 and 2019, 90% contain no human data on the risks or benefits for pregnant patients. About 80% of some 1,800 medications in a national database called TERIS, which summarizes evidence on medications’ risks during pregnancy, lack or have limited evidence about the risks for birth defects. Researchers have estimated that it takes 27 years to pin down whether a medication is safe to use in pregnancy.

As a result, many pregnant women stop treating their chronic diseases. In a U.S. study published in 2023, over one-third of women stopped taking a medication during pregnancy, and 36.5% of those did so without advice from a health care provider. More than half cited concerns about birth or developmental defects as the reason.

Yet uncontrolled chronic disease comes with its own toll on both the mother’s and the baby’s health. For example, some medications used to treat seizures are known to cause birth defects, but stopping them may increase seizures, which themselves raise the risk of fetal death.

Women with severe or recurrent depression who abruptly stop their antidepressants risk their depression returning, which is in turn associated with increased risk of substance use, inadequate prenatal care and other negative effects on fetal development. Stopping the use of medications
for treating high blood pressure also causes adverse effects – specifically, a greater risk of pregnancy-related high blood pressure that can cause organ damage, called preeclampsia; a condition called placental abruption, when the placenta detaches from the wall of the uterus too early; preterm birth; and fetal growth restriction. An online resource called Mother to Baby, created by a network of experts on birth defects, provides an excellent summary of the available data on medication safety during pregnancy.

The FDA in some cases requires drug companies to establish registries to track the outcomes of pregnancies exposed to certain medications. These registries can be useful, but they have shortcomings. For example, recruiting pregnant patients into them takes time and considerable effort, resulting in small sample sizes that may not capture rare birth defects. Also, registries typically follow a single medication and rarely include comparisons to alternative treatment approaches – or to no treatment.

What’s more, following the 2022 Dobbs v. Jackson Supreme Court decision overturning the constitutional right to abortion, women might be reluctant to add their names to a pregnancy registry or to provide data on prenatal detection of birth defects due to concerns about privacy and legal risks.

Decades of underfunding

In 2019, a task force established by the 21st Century Cures Act identified a major gap in knowledge about drug safety and effectiveness in pregnant and lactating women and recommended a boost in funding to fill it.

However, little has changed. A 2025 review by the National Academies of Sciences, Engineering and Medicine pointed out that research funding for women’s health topics has remained flat over the past decade, while the overall budget of the National Institutes of Health has steadily increased. The review recommended doubling the NIH funding allocated for such research, but this seems unlikely in light of the recent proposals to cut the overall NIH budget by 40%.

The National Institute of Child Health and Human Development funds the bulk of research on the safety of medications during pregnancy across federal agencies, although the institute has an appreciably smaller budget than most of its sister institutes such as the National Cancer Institute. Grants awarded are typically broad and take four to five years to complete, but they allow the more comprehensive assessments that are needed to support informed decisions considering outcomes for mother and child. For example, NIH-funded researchers have established a clear link between autism and prenatal use of valproate, a potent teratogen used to treat epilepsy and several mental health disorders.

The Centers for Disease Control and Prevention as well as the FDA have also funded specific pregnancy-related research. For example, following the COVID-19 epidemic, the CDC renewed its funding for studies that help expedite pregnancy safety studies for treatments that might be used for newly emerging infections. In response to emerging concerns about a substance called gadolinium, which is often used during MRI procedures, the FDA funded our own work on a study of almost 6,000 pregnant women, which found no elevated risk.

For healthy pregnancies, more research is critical

These efforts have laid a crucial foundation for evaluating medication safety and effectiveness during pregnancy. But keeping pace with the release of new medications and new ways they are used, as well as addressing the backlog of missing evidence for medications that were approved in the past millennium, remain a challenge.

Recent terminations of NIH-funded studies have focused on topics presumably relating to diversity, equity and inclusion. But research on safe and healthy pregnancies and on maternal health – for example, on the safety of COVID-19 vaccines during breastfeeding – has been affected as well.

The NIH has scaled back new grant awards by nearly US$5 billion since the beginning of 2025, and the odds for receiving NIH funding have plummeted. Proposed sweeping budget cuts for the CDC and FDA leave their role in supporting research on healthy pregnancies similarly uncertain.

In our view, removing or reducing ongoing investments in healthy pregnancies poses a danger to much-needed efforts to reduce excessive rates of stillbirths as well as infant and maternal deaths.

Almut Winterstein consults on medication safety issues to Merck, Syneos, Lykos and Novo Nordisk. She receives funding for pregnancy-related research from NIH, CDC, FDA, and the Gates Foundation.

Sonja Rasmussen receives funding from Harmony Biosciences, Axsome Therapeutics, Biohaven (acquired by Pfizer), Lundbeck, Novo Nordisk, and Myovant Sciences to serve on pregnancy registry scientific advisory committees. She also receives or has received funding from NIH, CDC, and FDA.

– ref. Pregnant women face tough choices about medication use due to lack of safety data − here’s why medical research cuts will make it worse – https://theconversation.com/pregnant-women-face-tough-choices-about-medication-use-due-to-lack-of-safety-data-heres-why-medical-research-cuts-will-make-it-worse-260783

Source: The Conversation – USA (3) – By David Higgins, Assistant Professor of Pediatrics, University of Colorado Anschutz Medical Campus

Guidance around COVID-19 vaccines has once again shifted after the Food and Drug Administration on Aug. 27, 2025, approved updated shots for the fall season, but for a more limited group than in prior seasons.

These changes, announced on X by Secretary of Health and Human Services Robert F. Kennedy Jr., raise new questions about eligibility and availability of COVID-19 vaccines for children.

As a pediatrician and researcher who studies vaccine delivery and health policy, I foresee these changes adding to the confusion facing parents and providers, just as this summer’s COVID-19 wave continues to rise.

How does the new guidance differ from before?

The FDA revoked the emergency use authorizations for COVID‑19 vaccines, a status used during public health emergencies that made it possible to provisionally approve vaccines swiftly during the pandemic. The agency also limited their approval to only people at higher risk of serious illness from COVID-19 infection, such as those over 65 or with underlying health conditions. But for children it is even more complicated.

The FDA approved two updated mRNA-based vaccines – Moderna’s vaccine for children 6 months and older and Pfizer’s vaccine – both targeting a new variant called LP.8.1, for children 5 years and older. The agency also approved an updated version of the the protein-based Novavax vaccine targeting a strain of the virus called JN.1 for children 12 years and older. But all three approvals are limited to children at higher risk of serious illness from COVID-19 infection.

Previously, all children 6 months and older were able to receive either the Pfizer and Moderna vaccines, with the Novavax vaccine available for anyone 12 years and older. These changes mean it may be significantly more difficult for infants and young children to get vaccinated, even though they remain at higher risk for complications from COVID-19 compared with the general population.

The decision comes as, for the first time in decades, guidance from federal health authorities and pediatric experts diverge. The Centers for Disease Control and Prevention no longer routinely recommends COVID-19 vaccines for healthy children ages 6 months to 17 years. The decision to take this approach bypassed the CDC’s normal independent review panel, creating concerns about credibility.

In contrast, the American Academy of Pediatrics recently issued its own guidance based on its review of the evidence. The AAP recommends that all children 6 months to 23 months old and children 2 to 18 years old at higher risk receive vaccines. They also emphasize that COVID-19 vaccines should be available for all children whose parents want them.

The AAP’s review of the evidence showed COVID-19 remains a serious risk for young children and kids with certain high-risk conditions. It also found that children are still being hospitalized and dying at rates similar to those with other illnesses for which vaccines are routinely recommended, such as influenza. And an independent expert group called the Vaccine Integrity Project confirmed that no new safety concerns have emerged relating to COVID-19 vaccines and that the vaccines remain effective.

How might access to COVID-19 vaccines for kids change?

Despite young children remaining particularly vulnerable, changes to FDA approval and conflicting recommendations will mean access to vaccines could be challenging.

Children under 5 years of age can now only receive Moderna’s vaccine. Providers who had planned to use Pfizer’s vaccine need to quickly pivot, and Moderna will need to fill supply gaps. Also, providers may not be able to use any Pfizer vaccine stock they still hold now that the emergency use authorizations is no longer in effect. Families who already face barriers to vaccination, such as those who live in rural areas or who lack health insurance, may be especially affected by these new limitations.

If providers give healthy children a COVID-19 vaccine, they would be doing this “off-label,” meaning different than what the FDA label says. This practice is legal and common, with an estimated 1 in 5 medications prescribed off-label. However, while physicians can give vaccines off-label, in many states, pharmacists and other non-physicians may not be able to do so for any age.

Even if it is legal, some providers may be hesitant to give COVID-19 vaccines off-label. After the AAP released its own recommendations, Kennedy warned that vaccine recommendations that diverge from the CDC’s official list are not protected from liability, though legal experts argue that this is misleading.

The AAP published a list of high-risk health conditions or characteristics to guide parents and providers in deciding whether a child should receive the vaccine.

At the federal level, the only current list is on the CDC website and is not specifically related to COVID-19 vaccine recommendations. For example, it includes pregnancy, even though federal health leaders have previously stated the vaccines would no longer be recommended in pregnancy. In contrast, the American College of Obstetricians and Gynecologists strongly recommends updated COVID-19 vaccination during pregnancy, when planning pregnancy, in the postpartum period and while lactating, noting benefits for both patients and their newborns.

What might happen next?

Unfortunately, the confusion may deepen as the CDC’s recommendations, including who is at high risk, may be revised after an upcoming meeting of the Advisory Committee on Immunization Practices, a panel of independent experts that advises the agency.

In June 2025, in an unprecedented move, Kennedy disbanded the entire committee and hand-picked new members. The new committee has yet to weigh in on COVID-19 vaccines for children. The chair of the COVID-19 vaccine work group, which will make recommendations to all committee members, is led by an outspoken critic of COVID-19 vaccines who does not have a biomedical degree or medical experience. Also, on Aug. 27, 2025, federal officials attempted to oust the CDC’s director just a few weeks after she was confirmed, and multiple top officials resigned.

The bottom line is that with these FDA changes, fewer vulnerable children may end up vaccinated against COVID-19 because of supply constraints, parental confusion or provider uncertainty. The best thing a family can do is talk with their pediatrician about what options remain and what is best for their child.

David Higgins volunteers as Vice President of the Colorado Chapter of the American Academy of Pediatrics and as a board member of Immunize Colorado. He was not involved in the development or publication of the American Academy of Pediatrics’ immunization guidelines. The views and opinions expressed in this article are solely his own and do not represent those of the American Academy of Pediatrics.

– ref. FDA approves updated COVID-19 vaccines with new restrictions, potentially limiting access for healthy children – https://theconversation.com/fda-approves-updated-covid-19-vaccines-with-new-restrictions-potentially-limiting-access-for-healthy-children-264098