| The anti-vaccine movement’s momentum in the regulatory and legislative arena has slowed. But advocates increasingly believe one of the movement’s biggest opportunities is in the courts, reports Lauren Weber in The Washington Post newsroom. A judge has put Health Secretary Robert F. Kennedy Jr.’s sweeping changes to the childhood vaccine schedule on ice. Kennedy has largely stopped publicly talking about vaccines amid polling indicating that it’s politically unpopular. And some efforts in statehouses to eliminate vaccine mandates, including in Iowa and Louisiana, have faltered. However, the legal argument that vaccine mandates without a religious exemption violate First Amendment religious freedoms could be the strategy to deliver the anti-vaccine movement a major win. “There are cases moving towards the Supreme Court from many different corners that are going to bring to a head this conflict and create this legal reckoning,” Mary Holland, head of Children’s Health Defense, the anti-vaccine group Kennedy founded, told a crowd of supporters in D.C. in March. The movement has devoted significant resources to that effort, Lauren reports. → Two of the most prominent anti-vaccine groups, Children’s Health Defense and Informed Consent Action Network, have spent nearly $50 million on legal expenses since 2016, according to a Post analysis of publicly available tax records. Why it matters: Vaccine rates against measles have fallen sharply across the country since the coronavirus pandemic, according to a previous Washington Post examination, with just over a quarter of U.S. counties reaching the level of herd immunity among kindergartners needed to protect against the preventable infectious disease. There have been nearly 2,000 measles cases in the U.S. so far this year, according to the Centers for Disease Control and Prevention — almost reaching the number of cases in all of 2025. Meanwhile, in 2024 and 2023 combined, there were fewer than 350 measles cases. Some public health experts worry that an erosion of mandates could lead to sustained outbreaks of preventable diseases, more hospitalizations and potential deaths. → However, as these groups work to challenge vaccine mandates, their leaders say that it is inaccurate to say they oppose vaccines. Holland told The Post in a statement that her group “is not anti-vaccine. We are pro-vaccine safety and anti-vaccine mandates.” The head of Informed Consent Action Network, Del Bigtree, said in a statement “we are not seeking to eliminate vaccines” but to ensure informed consent. Some groups have funded attempts — so far unsuccessful — to overturn a 1905 Supreme Court decision upholding the power of state governments to mandate vaccines to protect public health. But groups have now pivoted to religious freedom claims that could reshape or even weaken the legal foundation for vaccine mandates in the United States. WHAT TO WATCH The Supreme Court signaled in December that it may be open to a constitutional claim based on the lack of a religious exemption for vaccine mandates in New York, one of five states that do not allow such exceptions. → The high court sent the case, involving Amish parents, back to a lower federal appeals court, with instructions to evaluate a recent ruling allowing parents to opt out of LGBTQ materials in schools based on religious grounds. Legal watchers say that case, as well as others moving through the courts in West Virginia and California, could be the anti-vaccine movement’s best hope of a national legal win. What’s next: The New York case could go a few ways: The U.S. Court of Appeals for the 2nd Circuit could take the Supreme Court’s direction and revise its decision, essentially requiring the addition of religious exemptions in both New York and Connecticut, as it is part of the same federal circuit, legal watchers say. That could have a domino effect with other states. → If the 2nd Circuit still rejects a religious exemption, the high court could take it up again. But Lawrence Gostin, a Georgetown University professor who has been involved as an adviser and witness in some cases supporting vaccine mandates, said that “the [Make America Healthy Again] movement and the court itself should be very careful what they wish for.” “Because I think if this goes too far,” he told Lauren, “we’re going to see childhood diseases come roaring back with a vengeance.” Read the full story: “Courts may deliver the anti-vaccine movement’s biggest win.” The Food and Drug Administration’s updated guidance on dietary supplement oversight is moving closer to release after landing at the White House for review Tuesday. The guidance, last updated in 2024, is expected to spell out what evidence companies must provide to show new supplement ingredients are safe before they hit the market. Key context: The details remain under wraps, but the FDA has been wrestling with how to regulate a new generation of supplement ingredients such as peptides and enzymes. The agency held a public meeting in March focused on where those products fit within existing law, which was led in part by Kyle Diamantas, a top official who is now acting director of the agency. “It’s crucial that FDA be nimble and adaptable as we advance our regulatory frameworks, and [keep] pace with the rapidly growing commodity and related technological and scientific advancements,” Diamantas said at the March meeting. The agency’s regulatory framework has not kept pace with the innovation of the supplement industry, he said, and “it’s a goal of mine to modernize our oversight.” → Officials sought feedback on products made using newer manufacturing techniques, and on how FDA should evaluate ingredients that may not fit neatly into traditional categories. The discussion highlighted growing questions about how the agency should oversee a rapidly evolving supplement market. Consumer advocates argued that the supplement market is underregulated and new ingredients should be viewed with skepticism — while industry groups countered that the FDA should allow manufacturers to focus on “self‑modernization” within existing regulations. The nation’s largest pediatric hospital will be required to create the country’s first dedicated “detransition clinic” under a settlement that resolves Texas’s years-long investigation into its treatment of transgender youths, The Post’s Molly Hennessy-Fiske reports. The clinic will provide a wide range of medical and support services to patients who previously received gender transition care before age 21, according to a previously unreleased settlement agreement between Texas Children’s Hospital and Attorney General Ken Paxton (R) obtained by The Post through a public records request. The clinic’s services will be provided at no cost for five years. Under the terms of the agreement, which was coordinated with the Justice Department, Texas Children’s Hospital will pay $10 million to resolve allegations related to Medicaid billing practices, permanently stop providing what the agreement calls “sex-rejecting procedures” and bar five physicians from practicing at the facility. Read the full story: “Texas settlement papers describe nation’s first gender ‘detransition clinic.’” Why it matters: The settlement comes as the Trump administration ramps up scrutiny of providers and also seeks to block federal support for gender transition care for minors, cutting off funding to facilities that offer it. Major medical organizations have endorsed nonsurgical gender-affirming care — including counseling, puberty blockers and hormones — for young people, though one group walked it back slightly, arguing “insufficient evidence.” Critics, however, argue that the treatments can be harmful to children, who they say are too young to make such decisions and may ultimately regret it. The Justice Department has also sent subpoenas to hospitals, demanding information about providing this type of care. NYU Langone, a large New York-based health system, said last month it had received one of the subpoenas. What to watch: On Tuesday, transgender patients and their families sued the Trump administration to halt the release of their medical information and identities. It follows multiple other lawsuits designed to block the Justice Department from obtaining the information. The White House has nominated Ge Bai, a Johns Hopkins professor specializing in health care accounting, to serve as an assistant secretary at the Department of Health and Human Services. She’s already serving as the principal deputy assistant secretary for planning and evaluation at HHS. Bai has been a top proponent of providing patients with more access to health savings accounts as a way to bring down health costs, a policy favored by the Trump administration. She’s also been critical of how nonprofit hospitals operate, arguing that some exploit their tax-exempt status. (The industry has strongly pushed back on these allegations.) “From festering infections to untreated cancer, ICE detainees across the US describe medical neglect,” report Rae Ellen Bichell, Claire Galofaro, Maia Rosenfeld, Renuka Rayasam, Aaron Kessler and Byron Tau at the Associated Press and KFF Health News (and reposted by The Post). “States Form New Battleground for Pharma’s Fight Against Copycats,” write Nyah Phengsitthy and Ian Lopez at Bloomberg Law. “Eli Lilly’s top dealmaker says don’t be surprised to see more M&A that pushes Lilly into new areas,” Angelica Peebles reports at CNBC. “Long Covid Underdiagnosis Poses Broader Care, Coverage Hurdles,” Bloomberg Law’s Lauren Clason writes. “Leading Public Health Journal Suggests How To Define Ultra-Processed Foods,” Paige Winfield Cunningham writes at NOTUS. “Rubio Suggests U.S. Return to Global Vaccine Program in Rebuke of Kennedy,” Stephanie Nolen and Sheryl Gay Stolberg write at the New York Times. This newsletter is published by WP Intelligence, The Washington Post’s subscription service for professionals that provides business, policy and thought leaders with actionable insights. WP Intelligence operates independently from The Washington Post newsroom. Learn more about WP Intelligence. | 
