Political interference in vaccination policy and transnational implications for Latin America and the Caribbean

The United States (US) exerts strong normative and symbolic influence in global health, with its public health recommendations often echoed in Latin America and the Caribbean (LAC). Recent changes in childhood and maternal vaccination guidance by the US Department of Health and Human Services (DHHS) carry potential transnational implications. Once grounded in a solid scientific framework and consensus, US immunisation policy has become increasingly politicised after the COVID-19 pandemic, a shift associated with lower vaccine acceptance, reduced coverage, and higher morbidity and mortality from vaccine-preventable diseases—trends that heighten concern about their ripple effects beyond US borders.¹

There are moments in public health when the main threat is not a pathogen or a disease, but something more fragile: trust. On 5 January 2026, according to a statement from DHHS, several vaccines (RSV, rotavirus, hepatitis A and B, influenza, COVID-19, meningococcal) shifted from universal recommendation to “high-risk” only or “shared clinical decision-making”, following changes in the established recommendation process by the US Centers for Disease Control and Prevention (CDC).² Unilateral changes in the established process weaken public confidence in evidence-based recommendations issued by health authorities and supported by the scientific community.³ The erosion in trust and confidence in vaccine policy now taking shape in the US, transforms previously accepted scientific consensus into a matter of controversy.

For the LAC region, this is not distant “foreign news”. It represents a cross-border risk that travels through two powerful channels -people and narratives- and can result in more outbreaks, hospitalizations, long-term sequelae, and avoidable deaths from vaccine preventable diseases.

Professional societies in the US and LAC have warned that these changes may reduce coverage and increase outbreak risk.4, 5, 6 If these changes translate into weaker school requirements or increasing judicialisation of immunisation policies, the effect on social trust could be profound. When people see inconsistency from authorities, doubt becomes contagious; and once trust is lost, it is extremely difficult to rebuild. The changes are not merely semantic. In real life, a vague “shared decision-making” recommendation often means more doubt, more friction, and more inequity, affecting especially vulnerable populations —because those with resources, access, and stable medical careare left behind.

The problem is also political and economic. The US plays a central role in multilateral organisations, global financing, and the definition of international health priorities. When its commitment to science and public health becomes unstable and doubtful, the coalitions that sustain immunisation programmes in middle- and low-income countries are weakened. Recent history shows that setbacks in international cooperation translate into delays in implementation, shortages of vaccines, and avoidable deaths and suffering.^7,8

LAC faces risk through three main channels—epidemiological, communicational and institutional. As outbreaks increase and the number of susceptible individuals grows, countries with low or uneven vaccination coverage face a higher likelihood of imported cases. Vaccine debates originating in the US are rapidly disseminated across Spanish- and Portuguese-speaking countries through media and political discourse, and endorsements of anti-vaccination narratives by influential figures can amplify their cross-border impact. Institutional shifts are also relevant: framing universal recommendations as optional may encourage actors in LAC to weaken immunisation schedules on political rather than scientific grounds. LAC is not a passive recipient and also retains key comparative advantages⁹: many national immunisation programmes operate with a strong public mission and broad territorial reach, promoting vaccination as a shared responsibility, supported by sustained trust in health professionals.

Nationwide and community-based campaigns, along with regional funding mechanisms such as the PAHO Revolving Fund, facilitate pooled procurement and equitable access. Collective memory of recent epidemics also reinforces vaccination as a measure for protection and survival.

These strengths enabled LAC to eliminate polio in 1994 and interrupt endemic measles transmission in 2016, and they remain protective if action is timely. However, the loss of measles elimination status in North America after over 12 months of continuous circulation in Canada, the United States and Mexico adds pressure to a region already facing coverage gaps, post-pandemic fatigue and local political pressures that can magnify external influence. Institutional responses should be swift, safeguarding technical decision-making and insulating immunisation policies from political interference, to prevent further erosion of public trust.¹⁰

Strategies of mitigation and interventions to strengthen regional resilience must be implemented. To mitigate these transnational risks, the LAC region must move toward “health sovereignty”, with the objective of insulating immunisation programs from the volatility of political election cycles. To sustain and strengthen immunisation systems, several priority actions are needed. These include establishing legal frameworks that anchor vaccination policies in law and protect budgets from political turnover; and supporting technically rigorous, independent NITAGs operating at arm's length from ministries of health so their recommendations retain scientific credibility even when non-binding. Strengthening regional self-reliance is also important, including better use of existing vaccine manufacturing hubs in countries such as Brazil, Mexico, Argentina, Colombia, Costa Rica and Panama to move toward a more self-sufficient supply chain.

At the same time, multilateral cooperation remains essential. Strengthening funding mechanisms such as the PAHO Revolving Fund can promote transparent procurement processes that are shielded from short-term political pressures. In parallel, there is a growing need for organised digital counter-misinformation efforts, with dedicated task forces to address health misinformation across the region. Underpinning all of this is the responsibility to advocate for and protect populations, ensuring that people receive the well-established benefits of vaccination through clear, transparent and evidence-based guidance delivered by trusted health professionals.

As US medical professional societies have warned, when attempts are made to weaken vaccination schedules without a scientific frameworks and process, there is no technical equivalence between evidence and ideological positions.

Contributors

MLAA conceived the idea for this Comment and drafted the first version. All authors contributed to the design, critically revised the manuscript for important intellectual content, and approved the final version.

AI statement

OpenAI's ChatGPT was used to adjust the references to the journal's required format and to correct occasional spelling or grammatical errors. All content, data interpretation, and conclusions were reviewed and verified by the authors, who take full responsibility for the final version of the manuscript.

Declaration of interests

MLA: has received fees for vaccine lectures and for vaccine implementation strategies and vaccine hesitancy to MSD, Sanofi, Pfizer and consulting fees to Sanofi, MSD, Pfizer.

LHF: has received fees for vaccine lectures to Sanofi, MSD, GSK, and consulting fees to Sanofi.

XSLL: has received grants to Takeda, Moderna, Astra Zeneca, consulting fees to Sanofi, Takeda, Pfizer, MSD, Minaervax.

JB: has received fees for vaccine lectures to Sanofi, MSD, consulting fees to Sanofi, MSD. Pfizer and support for attending meettings to Sanofi, Pfizer, MSD.

FMM: Has been a DSMB member for Pfizer vaccines; reports research support from Pfizer, the US National Institutes of Health (NIH) and US Centers for Disease Control and Prevention (CDC); has served in advisory Committees for Moderna, Merck, Sanofi, GSK, Astra Zeneca; is a member of the Immunization Expert Group at the American College of Obstetrics and Gynecology (ACOG); Infectious Diseases Society of America (IDSA) Liaison to the Advisory Committee of Immunization Practices (ACIP) of the US CDC; member of the vaccines and related biologic products advisory committee (VRBPAC) of the US FDA; member of the Board of the National Foundation of Infectious Diseases (NFID). CTM: has received fees for vaccine lectures MSD, Sanofi, Pfizer, Takeda and consulting fees to Sanofi, MSD, Pfizer and Takeda. AG: declare no conflicts of interest.