A group of high-level managers at the Louisiana Department of Health walked into a Nov. 14 meeting in Baton Rouge expecting to talk about outreach and community events.

Instead, they were told by an assistant secretary in the department and another official that department leadership had a new policy: Advertising or otherwise promoting the COVID, influenza or mpox vaccines, an established practice there — and at most other public health entities in the U.S. — must stop.

NPR has confirmed the policy was discussed at this meeting, and at two other meetings held within the department’s Office of Public Health, on Oct. 3 and Nov. 21, through interviews with four employees at the Department of Health, which employs more than 6,500 people and is the state’s largest agency.

According to the employees, who spoke on the condition of anonymity because they fear losing their jobs or other forms of retaliation, the policy would be implemented quietly and would not be put in writing.

Staffers were also told that it applies to every aspect of the health department’s work: Employees could not send out press releases, give interviews, hold vaccine events, give presentations or create social media posts encouraging the public to get the vaccines. They also could not put up signs at the department’s clinics that COVID, flu or mpox vaccines were available on site.

The new policy in Louisiana was implemented as some politicians have promoted false information about vaccines and as President-elect Donald Trump seeks to have anti-vaccine activist Robert F. Kennedy Jr lead the U.S. Department of Health and Human Services. And some public health experts are concerned that if other states follow Louisiana, the U.S. could face rising levels of disease and further erosion of trust in the nation’s public health infrastructure.

At a Dec. 16 news conference, Trump addressed ongoing concerns about Kennedy’s nomination, and whether it could lead to significant changes in national vaccine policy.

Trump said that Kennedy will be “much less radical than you would think” and that he has “a very open mind.” Trump also called himself a “big believer” in the polio vaccine and said “you’re not going to lose the polio vaccine.”

A blow to public health practice

Staff at Louisiana’s health department fear the new policy undermines their efforts to protect the public, and violates the fundamental mission of public health: to prevent illness and disease by following the science.

“I mean, do they want to dismantle public health?” one employee at the health department said.

“We’re really talking about deaths,” said another. “Even a reduction in flu and COVID vaccines can lead to increased deaths.”

Gov. Jeff Landry’s office referred questions to the Louisiana Department of Health, and did not respond when asked if Landry supports the changes.

In a statement, the Louisiana Department of Health told NPR it has been “reevaluating both the state’s public health priorities as well as our messaging around vaccine promotion, especially for COVID-19 and influenza.”

The statement described the move as a shift “away from one-size-fits-all paternalistic guidance” to a stance in which “immunization for any vaccine, along with practices like mask wearing and social distancing, are an individual’s personal choice.”

The statement did not address mpox vaccinations.

The statement said that the flu vaccine can reduce illness severity and therefore may help high-risk patients — but falsely claimed “the flu vaccine does not prevent one from getting the influenza virus.” According to the Centers for Disease Control and Prevention, the vaccine reduces the risk of getting the flu.

Experts fear consequences of undermining trust in vaccine

Last year, 652 people in Louisiana died of COVID, including five children. Louisiana currently is tied with DC for the highest rate of flu in the U.S. In 2022 alone, flu killed 586 people in Louisiana.

Every health department staff member, former staff member, public health official and vaccine expert contacted by NPR repeated the scientific consensus that vaccines are safe, effective, and essential for preventing illness, hospitalizations, and deaths.

“It’s a step backwards,” said Kimberly Hood, who led the Office of Public Health, a subunit of the health department, from 2021 to 2022. “It’s a medical marvel that we’re fortunate enough to live in a time where these vaccines are available to us, and to not make use of that tool is unconscionable.”

The policy rises to the level of “absurdity,” said Dr. Paul Offit, director of the Vaccine Education Center at the Children’s Hospital of Philadelphia. “It’s gotten to the point of parody, where a public health agency doesn’t promote the public’s health.”

“It’s a dangerous, dangerous thing,” Offit said. “It’s the most vulnerable among us who suffer this, and it will be our children who suffer this. And my question will be, will they be held accountable?”

The policy is akin to “malpractice,” especially given Louisiana’s poor health outcomes, said Dr. Georges Benjamin, the executive director of the American Public Health Association (APHA).

The U.S. vaccination program represents “one of the most important public health interventions that we have,” Benjamin added.

“It’s reckless,” said Lawrence Gostin, a professor of global health law at Georgetown University. “I think it’s a sign of what is about to happen under the second Trump administration.”

If U.S. senators confirm Kennedy to run HHS, he said, “we’re going to see the fomenting of public distrust of vaccines so we lose precious herd immunity, and we’re going to see major outbreaks of disease that are fully preventable over the next four years.”

NPR reached out to Kennedy for comment but did not hear back.

Policy change follows new governor’s election

Until becoming Louisiana governor in early 2024, Republican Jeff Landry served as the state’s attorney general for eight years. During the pandemic, he criticized the state’s COVID response and filed lawsuits over federal and state vaccine mandates.

On Dec. 6, 2021, Attorney General Landry spoke at a state committee hearing against adding COVID to the childhood immunization schedule. At his side was Robert F. Kennedy, Jr., who presented false claims about COVID vaccines.

This year the Republican-controlled legislature passed five bills — all signed by Gov. Landry — and two resolutions aimed at loosening vaccine requirements, limiting the power of public health authorities and sowing doubt about vaccine safety.

Gov. Landry also appointed Dr. Ralph Abraham, a family medicine doctor, to be the state’s surgeon general. That position co-leads the Department of Health, and is tasked with crafting health policy that is then carried out by the departmental co-leader, the secretary.

Dr. Wyche Coleman, an ophthalmologist, was named deputy surgeon general.

At a Sept. 26, 2024 legislative meeting on the state’s handling of the COVID pandemic, Abraham and Coleman repeated misinformation about COVID vaccine safety and the debunked link between vaccines and autism.

“I see, now, vaccine injury every day of my practice” from COVID vaccines, Abraham said.

Abraham said masking, lockdowns and vaccination requirements “were practically ineffective,” that COVID vaccine adverse effects have been “suppressed,” that “we don’t know” whether blood from people who’ve been vaccinated is safe for donation and that “we hope and pray” COVID vaccines don’t increase the risk miscarriages.

Surgeon General Abraham also said “there’s nothing wrong” with Louisiana conducting its own research into whether childhood vaccines cause autism.

“You could probably fill Tiger Stadium with moms who have kids that were normal one day, got a vaccine and were then autistic after,” said Deputy Surgeon General Coleman at that meeting.

Those public comments by Abraham and Coleman are inaccurate and alarming, according to public health experts.

“Anyone who’s articulating that these vaccines are not well tested, they’re not safe, they’re not effective, is not giving you the science as we know it today,” said APHA’s Benjamin.

“To have top public health officials peddling such scientific falsehoods and threatening the health of their populations, whom they’ve sworn an oath to serve, almost makes me cry,” said Georgetown’s Gostin.

In three meetings, surprise and confusion at new policy

The new ban on vaccine promotion represents a new level of political interference, according to two current health department employees.

“We’ve never felt so unsure of our future,” one of them said. “Like, why am I here? Why am I doing this anymore? Because you’re just so stifled and you are not helping people.”

In the Oct. 3 meeting, Deputy Secretary Dr. Pete Croughan, an internal medicine physician, told the state’s regional medical directors that they weren’t allowed to hold routine fall flu vaccination events, according to a staff member with knowledge of what was discussed at the meeting.

These flu shot events had become a key part of the health department’s flu campaign in recent years, which included spending over $170,000 annually on outside public awareness campaigns that included paid billboards, bus ads, radio, digital, and social media ads urging the public to get vaccinated for the flu.

This year, instead of flu vaccine events, the medical directors were told to pivot to Narcan giveaways.

The department’s influenza page doesn’t appear to have been updated this year; it still promotes events from 2023.

The department also appears to have pulled back from vaccination messaging on social media channels.

Last fall, it published six Instagram posts promoting flu and COVID vaccinations, and specific vaccine events. In the last three months, the health department’s Instagram has had no posts about vaccination, and just a single post about flu.

That recent post lists preventative measures like hand washing, but not vaccination.

That stands in stark contrast to a flu post from the fall of 2020 which stated “it’s more important than ever to get your flu vaccination to protect yourself and those around you.”

Regional medical directors are responsible for carrying out the health department’s policy and programs across the state.

In the meeting, Croughan told them if they want to bring doses of flu vaccine to a local event, they can’t use signage or even tablecloths featuring the health department’s logo.

“You cannot ask people, ‘Hey, we have flu shots. Would you like one?'” at a community event, according to the staff member with knowledge of the meeting. “But if they come up to us, knowing we are the health department and say, ‘Hey, we hear y’all might have flu shots,’ we can say, ‘Yes, would you like one?'”

The medical directors were told that because the health department is a government agency, staff are not allowed to “coerce people” by promoting vaccinations, especially for COVID, flu and mpox. “They have definitely made it clear that we are not supposed to be pushing vaccines at all,” the staff member added.

There has been no explanation for why these particular vaccines were grouped together.

“Why on earth they chose COVID, influenza and mpox vaccines, which are entirely different vaccines for entirely different purposes, just shows a lack of sophistication and understanding of science,” Gostin said.

“I can’t think of any reason other than political reasons,” said Hood, the former head of the Office of Public Health.

Opposition to COVID vaccines has gained momentum within the Republican Party, as part of the backlash to pandemic-related public health measures. When it comes to the flu vaccine, Kennedy’s anti-vaccination nonprofit, the Children’s Health Defense, has made multiple false claims about its dangers.

Policy may stem from surgeon general’s letter  

At the Nov. 14 meeting, the new prohibitions were relayed to program staff by Tonya Joiner, an assistant secretary in the department and the head of the Office of Public Health, and Katye Magee, a policy director.

Employees were told that Joiner and Magee were relaying the policy because Surgeon General Ralph Abraham could not attend.

Staffers asked them what exactly they can say about COVID, flu and mpox vaccines, going forward.

They were told acceptable public vaccine messaging should be something along the lines of: Talk to your medical provider.

“That seemed to be the catchphrase for all of this,” said one staff member with knowledge of the meeting.

The secretive rollout of the new policy raised concerns about government transparency and accountability, and a former state employee with knowledge of the state’s health policies said it was “highly abnormal” to deliberately keep the policy out of writing.

“I’m very surprised that anyone would call a state meeting, not provide an agenda for that meeting, not provide a written set of notes from that meeting,” said Hood. “I think that, to me, it sounds like people are trying to avoid public records laws.”

When employees in the meeting asked for the rationale for the policy change, leadership referenced a letter signed by Abraham and Coleman stating that there is no “conclusive evidence” that masking prevents the spread of respiratory viruses and that “evidence proving efficacy in prevention of infection, transmissions, hospitalization or deaths is far from conclusive” for the flu vaccine.

That letter provides a template for a Louisiana physician to use to get an exemption from a hospital’s flu vaccination and masking policies. The letter, on Louisiana Department of Health letterhead, is not available on the department’s website but was posted to X on Nov. 13, the day before it was mentioned in the meeting.

In the letter, Abraham and Coleman also said requiring hospital staff who do not get the flu vaccine to wear a mask was “punitive coercion.”

One Louisiana health professional not employed by the department said the letter was “crazy. I’m just going to say it. Complete falsehoods.”

At the third meeting, on Nov. 21, the STD/HIV/Hepatitis program at the department held a staff meeting where more than 80 employees learned of the ban on promoting COVID, mpox and flu vaccines, according to two staff members. Employees were also told the policy would not be put in writing.

When staff asked whether the policy applied to hepatitis B vaccinations, they were told “there was no official response to that yet,” said a staff member who attended the meeting.

“There were so many questions and concerns,” the staff member said. “A lot of folks were disappointed and just frustrated.”

A slippery slope to future disease outbreaks

Experts told NPR they feared a policy that undermines COVID, flu and mpox vaccinations could have a spillover effect, reducing public trust in vaccinations overall, including those given to children to prevent a host of dangerous and deadly illnesses.

“I believe that we will see measles cases. I believe we will see whooping cough cases. I believe we will likely see meningitis outbreaks,” said Hood.

In the Nov. 14 meeting, a staff member asked whether the ban on promoting vaccines applied to children’s immunizations, but the answer was noncommittal, according to an employee with knowledge of the meeting’s details.

“My understanding was it’s not clear to what extent we might be able to promote childhood vaccinations,” the staff member said.

(The Louisiana Department of Health’s statement to NPR said the changes in policy and messaging do not apply to childhood immunizations.)

Nationally, vaccination rates for serious childhood diseases have been falling in recent years, including in Louisiana.

Given those trends, the new vaccine policy in Louisiana is very worrying, said Dr. Joseph Bocchini, a pediatric infectious disease specialist in Shreveport, Louisiana, and the president of the Louisiana chapter of the American Academy of Pediatrics.

Earlier in his career, he saw children hospitalized with measles — a dangerous disease that can cause hearing loss, brain damage and death.

“I’ve been a physician for 50 years, so I’ve seen a lot of these diseases disappear, and they’ve disappeared because of safe and effective vaccines,” he said.

The rise of public health officials promoting misinformation

Louisiana isn’t the only state where public health officials have recently announced controversial decisions and repeated false or discredited health theories.

Florida’s surgeon general has made false claims about COVID vaccines, undermined school vaccine mandates for the measles and said local officials should stop adding fluoride to water supplies.

Hood traced Louisiana’s new policy, in part, to Kennedy’s ties to Louisiana’s Republican Party.

“Robert F. Kennedy Jr. came to the legislature while I was still in my role at the Office of Public Health, to speak out against the COVID vaccine,” she said, referencing his Dec. 6, 2021, appearance with Gov. Landry. “So I was not 100% stunned to hear his influence was going to be felt in this administration.”

Louisiana’s ban represents an escalation in using vaccine misinformation to direct state health policy, according to James Hodge, a public health law expert at Arizona State University’s Sandra Day O’Connor College of Law.

“What’s very distinct is some sort of official policy advanced by the state department of health saying you may not push and or promote these vaccines at all,” Hodge said. “That’s derelict. It’s highly controversial.”

But it’s the kind of policy the nation could see if Kennedy is confirmed as secretary for Health and Human Services, Hodge added. In a list he made of possible actions the Trump administration could take, Hodges placed “revising CDC vaccine recommendations” at the top.

This story comes from NPR’s health reporting partnership with WWNO and KFF Health News.