Surgeon general nominee and senator face off over vaccines and ‘shared decision-making’

STAT News · Feb 25, 2026 · Collected from RSS

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An eight-minute exchange at the end of Casey Means’ two-hour confirmation hearing captured the potential and the predicament the MAHA movement has created for itself. Means, an entrepreneurial wellness influencer with a medical degree from Stanford, appeared on Wednesday at the Senate health committee to be confirmed as the U.S. surgeon general. She came prepared with testimony focused on the rise of chronic disease and the need for “restoring wholeness for Americans — physically, mentally, and societally.” As a leader of health secretary Robert F. Kennedy Jr.’s Make America Healthy Again movement, she received a friendly reception for many of her positions on improving nutrition, finding the “root causes” of diseases, and fighting the sometimes harmful effects of social media on children. But at the beginning and end of the hearing, she found herself being pressed on the issue of vaccination by committee chair Bill Cassidy (R-La.), himself a physician. Cassidy provided the pivotal vote a year ago to confirm Kennedy as health secretary, but only after extracting various promises from Kennedy on vaccines — many of which have been broken. On Wednesday, Cassidy appeared determined to revisit the issue. One of his first questions to Means was about “promotion of vaccine skepticism.” Means repeatedly invoked shared decision-making — a term that is itself contentious — between doctors and parents, called for more research studies about potential links between vaccine and autism despite long-settled answers, and demonstrated support for new vaccine guidelines put in place by a vaccine advisory panel remade by Kennedy to reflect his views. Cassidy’s initial questions covered measles, flu, and whooping cough, which is having an outbreak in his state of Louisiana. “Children have actually died from it. Think about it, about the age of your child dying from a vaccine-preventable disease. And some have been scared to vaccinate their children because they’ve been told incorrectly that vaccines cause autism,” he said. “Do you believe that vaccines, whether individually or collectively, contribute to autism?” Means did not answer directly, but praised the administration for committing $50 millions in funding to look at environmental factors that might contribute to autism. Cassidy wanted more on vaccines being falsely linked to autism. “A lot of evidence is showing that they’re not implicated. Do you not accept that evidence?” he asked. “I do accept that evidence. I also think that science is never settled,” she replied. Most contentious was the question of when to give hepatitis B vaccines. Despite overwhelming evidence in favor of giving doses to newborns (a 90% reduction in infections), the new Centers for Disease Control and Prevention guidance leaves that decision to parents and doctors, overturning a universal recommendation to administer the vaccine at birth to prevent serious liver disease. Other senators of both parties also took up the theme of vaccines. Lisa Murkowski (R-Alaska) spoke of hepatitis B risk among Native populations in western Alaska. “I need to try to understand your thinking on that, given the medical consensus that this vaccine prevents this serious liver disease and liver cancer that we again were able to demonstrate in real time, real life, with that recommendation and now the view that you seem to be taking on this is not necessary for newborn,” Murkowski said. Means replied that her views were being misrepresented.“I do think that this administration is committed to making sure we have the safest vaccine schedule and that parents have the opportunity to have shared clinical decision-making on specific vaccines with their doctor so they can make the best decisions for their family,” Means said. “This is not a condemnation of vaccines generally, which I am very supportive of. However, I do believe that the thrust towards parents wanting to have the ability to have shared clinical decision-making with their doctor is important when there are conditions like hepatitis B, where there’s differential risk amongst different populations.” When Bernie Sanders (I-Vt.) said, “Secretary Kennedy and the Trump administration continue to spread dangerous conspiracy theories of vaccines,” Means tried to distance herself. “I don’t mention the word ‘vaccine’ in my book,” she said. “I am not here to complicate the issue on vaccines, and also I, as a physician, am very careful with my words, and I don’t think it’s responsible to say that we’re not going to study when kids are getting many medications. I think it’s important to just keep it on the table.” Well after the two-hour mark, after all the senators on the committee had had their chance to praise or poke at the nominee, Cassidy reclaimed the microphone, citing chair’s prerogative to ask final questions. Cassidy told Means she had “presented very well” and called her concerns about metabolic disease very important. “And by the way, I agree with that totally.” But again and again, he asked Means what shared decision-making would look like, when pediatricians already routinely talk with parents about vaccinations. “What I’m trying to get at, are you asking for a formal informed consent, as if somebody’s going for bypass surgery or somebody’s going for an appendectomy for an immunization?” Cassidy said in his fourth attempt. “I’m not necessarily advocating for that,” she said. “Many American parents are frustrated by what they feel like is a lack of transparency on the issue of vaccines, and I think doing what we can as medical leaders, what would that be? It’s encouraging a culture shift towards making sure that we’re respecting parent questions, choices.” Cassidy discounted the need for a cultural shift between doctors and parents. Then he again pressed Means about whether there should be a universal recommendation for hepatitis B vaccination at birth. At one point, Means said, “I feel like we’re going in a semantic loop here.” Five questions later, she answered with only measured support.“I think there are many parents, and I think the administration questions whether this vaccine is necessary for all children on the first day of life,” she said. Cassidy tried again, asking, do “you agree that universal hepatitis B immunization is a goal we should be shooting for?” Means, after once again mentioning parents’ qualms, said: “And I think that certainly, if we’re talking more broadly about promoting universal vaccination in children at some point in childhood, I think that’s a worthy goal.” “OK,” Cassidy said. The only other thing Means said was, “Thank you, Senator Cassidy.” STAT’s coverage of chronic health issues is supported by a grant from Bloomberg Philanthropies. 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