News Release

New KFF-Washington Post Survey Explores Parents’ Trust In, and Confusion About, Childhood Vaccines as the Trump Administration Revamps Federal Policies

Most Parents Remain Confident in Routine Childhood Vaccines and Support School Mandates, But Are Less Certain About Seasonal Flu and COVID Vaccines; 1 in 4 MAGA Republicans Say They Have Delayed or Skipped a Child’s Vaccine

Published: Sep 15, 2025

A new KFF-Washington Post partnership survey of parents explores their experiences with and views about vaccines for their children, including a look into how they make decisions related to vaccines and where they are uncertain or confused about their safety.

The poll comes as the Trump administration’s Health and Human Services Secretary Robert F. Kennedy Jr. continues to question the childhood vaccine schedule and to raise doubts about vaccine safety and effectiveness. Based on interviews with more than 2,700 parents, including more than 1,000 parents with children under age 6 who have had to make decisions about vaccines in the post-COVID era, the survey’s findings will be featured in a series of Washington Post stories and KFF reports analyzing the survey data.

The survey reveals large majorities of parents view long-standing childhood vaccines such as the ones to prevent measles, mumps, and rubella (MMR) and polio as safe and important, but are less confident in seasonal vaccines for flu and especially COVID-19.

While most parents say they keep their children up to date on recommended childhood vaccines, about one in six (16%) say that they have delayed or skipped at least one vaccine for their children (other than those for flu and COVID-19). Those most likely to report delaying or skipping vaccines include Republican parents (22%), especially those who identify with President Trump’s “Make America Great Again” movement (25%), parents under age 35 (19%), and those who homeschool their child (46%).

Among parents who delayed or skipped some vaccines for their children, the most common reasons include concerns about side effects, a lack of trust in vaccine safety, and a belief that not all recommend vaccines are necessary.

This is the 37th survey in the KFF-Post partnership dating back to 1995 that combines survey research with in-depth journalism. The Post today published its overview of the results, while KFF published a report breaking down the data. The Post plans to publish additional stories drawing on the survey results.

Key themes from the survey include:

Most favor school vaccine requirements. A large majority (81%) of parents say that public schools should require students to get the measles and polio vaccines, with exceptions for medical and religious reasons. Among all parents, 8% say that they had requested an exemption to vaccine requirements so a child could attend school or daycare.

Many are uncertain about false claims. When asked about several false claims about vaccines and measles, relatively few parents believe the untrue statements, but larger shares are uncertain what to believe. One example: While relatively few (9%) parents believe the false claim that the MMR vaccine can cause autism in children, nearly half (48%) say they don’t know enough to say.

Views of parents with children diagnosed with autism spectrum disorder. Parents of children with autism spectrum disorder are somewhat more likely than other parents to believe the false claim that vaccines cause autism (16% vs. 9%).

Confidence in federal health agencies is shaky. Fewer than one in six (14%) parents say they have “a lot” of confidence in government health agencies like the Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration to ensure the safety and effectiveness of vaccines, while half say they have only a little confidence (29%) or none at all (22%). Confidence is even lower in the agencies’ abilities to make decisions based on science rather than the views of agency officials or to act independently without interference from outside interests. A quarter (26%) of parents overall say that the CDC recommends too many vaccines.

Many parents are unsure about impact of federal vaccine policy changes. Few parents (11%) say they’ve heard “a lot” about Secretary Kennedy’s changes to federal vaccine policy. When asked about the changes’ impact, most say either that they don’t know or that the changes won’t make of a difference on safety, access, and industry influence.

The survey also examines parents’ views of the safety testing for vaccines, the number of recommended vaccines, and experiences with the human papillomavirus (HPV) vaccine.

METHODOLOGY INFO:

The KFF/Washington Post Survey of Parents includes interviews with a nationally representative sample of 2,716 parents or legal guardians of children under age 18 in the U.S. The survey was conducted between July 18-August 4, 2025, online, in English and Spanish, using the Ipsos KnowledgePanel. The margin of sampling error including the design effect for total sample of parents is plus or minus 2 percentage points. For results based on other subgroups, the margin of sampling error may be higher.

Poll Finding

KFF/The Washington Post Survey of Parents

Published: Sep 15, 2025

Overview

The Survey of Parents is the 37th in a collaborative reporting series between KFF and The Washington Post, dating back to 1995, that combines survey research with in-depth journalism. Based on interviews with more than 2,700 parents, including more than 1,000 parents with children under age 6 who have had to make decisions about vaccines in the post-COVID era, this survey explores parents’ experiences with and views about vaccines for their children.

As HHS Secretary Robert F. Kennedy Jr. questions the federal childhood vaccine schedule, debates over safety, access, and trust in public health guidance are front and center, leaving many parents confused about some of the most important decisions they’ll make for their children’s health. This poll offers a snapshot of how parents view childhood and routine vaccines, and the decisions they’re making for their children. These findings highlight where parents agree on the importance of long-standing vaccines, and where some attitudes have started to diverge in the wake of the COVID-19 pandemic.

Explore The Washington Post’s journalism:

Why 1 in 6 U.S. parents say they skipped or delayed their kids’ vaccines, Sept. 15, 2025

RFK Jr. drives a wedge between red and blue states on vaccines, Sept. 4, 2025

Key Findings

  • Large majorities of parents have positive views of long-standing childhood vaccinations for measles, mumps, and rubella (MMR) and polio, saying these vaccines are important for children in their community to get (90% and 88%, respectively) and that they are confident they are safe for children (84% and 85%). About eight in ten parents support current state laws, saying students should be required to be vaccinated against measles and polio to attend public schools with some exceptions (81%). These views are consistent across partisan lines, with large majorities of parents who identify as Democrats, independents, and Republicans viewing MMR and polio vaccines as safe and important for children to get and supporting policies that require these vaccines in public schools.
  • Views on seasonal vaccines for flu and especially COVID-19 are more divided, with much smaller shares of parents expressing confidence that these vaccines are safe for children (65% for flu and 43% for COVID-19) and saying they are important for children in their community to get (56% and 43%, respectively). Parents’ views on COVID-19 and flu vaccines divide along partisan lines, with Democratic parents much more likely than Republican parents to hold positive views of both. Republican parents who support the Make America Great Again (MAGA) movement express the most skeptical attitudes towards vaccines for children, particularly when it comes to confidence in the safety of COVID-19 (14%) and flu (48%) vaccines.
  • In addition to partisan divisions, parents under age 35 express greater concern about vaccine safety compared with parents ages 35 and over, perhaps an indication of shifting attitudes with younger generations of parents. For example, four in ten (39%) younger parents say vaccines do not go through enough safety testing before being recommended for children compared with about one-third (35%) of parents ages 35 to 49 and one quarter (26%) of parents ages 50 and older.
  • While a large majority of parents report keeping their children up to date on vaccinations, one in six (16%) parents say they have ever skipped or delayed at least one childhood vaccine other than flu or COVID-19 immunizations. About one in five Republican parents (22%), rising to one in four MAGA Republicans (25%), report skipping or delaying any childhood vaccines, higher than the share of Democratic (8%) parents who report this. Younger parents are also somewhat more likely to report skipping or delaying vaccines than older parents, regardless of the age of their children; 19% of parents under age 35 say they have skipped or delayed at least one childhood vaccine compared with 12% of those age 50 and over. Most parents who skip or delay vaccines cite side effects and safety as their top reasons, while few cite reasons related to a child’s health condition or access to health care.
  • Before his confirmation and in his role as HHS Secretary, Robert F. Kennedy Jr. has amplified claims about vaccines that have been rejected by scientists and public health officials. He has suggested, without evidence, that the number of recommended childhood vaccines has led to a rise in chronic disease in the U.S., that MMR vaccines can cause autism, and that the measles vaccine causes the illness it prevents. More recently, Kennedy has promoted Vitamin A as an effective treatment for measles. Asked about each of these claims, many parents are uncertain what to believe. While about one in ten or fewer parents say each claim is true and between a quarter and half say each is false, substantial shares – between four in ten and two-thirds – say they don’t know enough to say. On the widely circulated claim that MMR vaccines can cause autism in children, 9% of parents believe this to be true, rising to 16% among parents who have a child with autism spectrum disorder.
  • Six in ten parents have heard little to nothing about HHS Secretary Kennedy’s recent changes that could impact vaccine policies in the U.S., while just one in ten (11%) have heard “a lot” and one-quarter (27%) have heard “some” about these changes. Awareness is higher among older parents, Democratic parents, and parents with a college degree. When asked how they expect these changes to impact vaccine policy in the U.S., parents are divided, and many are not sure whether they will have an impact on access to vaccines, safety, or the influence of pharmaceutical companies. Democratic parents are considerably more likely than Republican parents to say these changes will make access more difficult (52% vs. 7%) and will make childhood vaccines less safe (40% vs. 5%). Republican parents are more likely than Democrats to say Kennedy’s changes will decrease pharmaceutical companies’ influence on vaccine policy (32% vs. 11%) but most parents across groups expect no changes or say they’re not sure.

Parents’ Views of Vaccine Safety and Importance

Parents overwhelmingly value long-standing childhood vaccines but are more divided when it comes to the COVID-19 and flu vaccines for children. Across parties, large majorities of parents see the measles, mumps, and rubella (MMR) and polio vaccines as important for children in their communities and are confident in their safety, but opinions on flu vaccines and especially COVID-19 vaccines are more mixed and sharply divided along partisan lines.

About nine in ten parents say it is important for children in their community to receive vaccines for MMR (90%) and polio (88%), including about seven in ten who say each is “very important” (70% and 68% respectively). A smaller share, but still a majority (56%) of parents say it is important for children in their community to be vaccinated against the flu, while fewer than half (43%) say the same about COVID-19, including one in five who say it is “very important.”

Nine in Ten Parents Say It Is Important for Children To Be Vaccinated Against MMR and Polio, Fewer Say the Same About the Flu and COVID-19

 While large majorities of parents regardless of partisanship agree that the MMR and polio vaccines are important for children to get, parents are divided along partisan lines when assessing the importance of COVID-19 and flu shots for children in their community. Democratic parents are more than three times as likely as Republican parents to say it is “very” or “somewhat” important for children in their community to be vaccinated for COVID-19 (68% vs. 21%) and twice as likely to say it is important for children to be vaccinated for the flu (78% vs. 38%). About four in ten independent parents (43%) say the COVID-19 vaccine is important for children, and just over half (55%) say the same of the flu vaccine.

Republican parents are not a monolith, as those who support the Make America Great Again (MAGA) movement are between 9 and 16 percentage points less likely than non-MAGA Republican parents to say each of these vaccines are important for children to receive. Even still, a majority of MAGA Republican parents and non-MAGA Republican parents alike say it is important for children in their community to receive MMR and polio vaccines.

Majorities of Parents Across Partisans Say It Is Important for Children To Be Vaccinated for MMR, Polio; Partisans Are Divided on Flu, COVID-19 Vaccines

Mirroring parents’ opinions on the importance of childhood and annual vaccines, large majorities of parents express confidence in the safety of childhood vaccines for polio and MMR, while views on the safety of flu and COVID-19 vaccines are more divided.

Just over eight in ten parents say they are either “very” or “somewhat confident” that polio vaccines (85%) and MMR vaccines (84%) are safe for children, including about half who say they are “very confident” (53% and 54% respectively). A smaller majority of parents express confidence in the safety of flu vaccines (65%), including about one-third who are “very confident” (34%). About four in ten (43%) parents are confident in the safety of COVID-19 vaccines for children, including one in five who are “very confident.”

Large Majorities of Parents Are Confident MMR and Polio Vaccines Are Safe for Kids, While Fewer Say the Same About Flu and COVID-19

While majorities of parents across partisanship say they are confident in the safety of polio and MMR vaccines for children, confidence in the safety of annual flu and COVID-19 vaccines for children differs.

At least eight in ten parents across partisanship say they are least “somewhat” confident in the safety of MMR and polio vaccines for children. About eight in ten (82%) Democratic parents say they are confident in the safety of flu vaccines for children, larger than the share of Republican (55%) or independent (64%) parents who say the same. Partisans are more deeply divided on confidence in the COVID-19 vaccine. Seven in ten Democratic parents say they are confident in the safety of COVID-19 vaccines for children, more than three times the share of Republicans who say the same (70% vs. 22%). About four in ten (43%) independent parents say they are confident in the safety of the COVID-19 vaccine for children.

The public overall and parents in the U.S. have been divided along partisan lines when it comes to the COVID-19 vaccine since it became available in 2021, when Republican adults were particularly hesitant to get themselves or their children vaccinated, past KFF polling finds.

The division when it comes to the flu vaccine, however, is more prominent now since the pandemic, and may be linked to concerns about vaccines generally. While the newly reformed Advisory Committee on Immunization Practices (ACIP) under HHS Secretary Kennedy has reaffirmed the existing recommendation that anyone ages 6 months and older should receive an annual flu vaccine, the panel recommended against vaccines containing a preservative called thimerosal, which has been falsely linked to autism. This recommendation comes despite scientific evidence that these vaccines are safe. Vaccines containing thimerosal comprised less than 6% of the U.S. influenza vaccine supply in 2024.

Parents Are Divided Along Party Lines on Confidence in Flu, COVID-19 Shot Safety for Children; Large Majorities Are Confident in MMR, Polio Vaccine Safety

Black parents and parents under age 35 are less likely than other groups to say they are confident in the safety of some vaccines. For example, just over half (55%) of Black parents say they are confident the flu vaccines are safe for children compared to about two-thirds of White parents (64%) and seven in ten (69%) Hispanic parents. While majorities across racial and ethnic groups express confidence in the safety of MMR and polio vaccines, Black parents are at least 10 percentage points less likely than White parents and Hispanic parents to express confidence in the safety of each of these vaccines.

Parents under age 35 are also less likely than older parents – particularly those ages 50 and older – to say they are either “very” or “somewhat confident” that routine vaccines are safe for children. The widest gap between younger and older parents is on confidence in the safety of COVID-19 vaccines for children, with just under four in ten (38%) parents under age 35 expressing confidence compared to about half (51%) of parents ages 50 and older.

Fewer Younger Parents and Black Parents Are Confident in the Safety of Some Vaccines for Children

Parents’ Views of Vaccine Safety Testing, Schedule, and Spacing

In his role as HHS Secretary, Robert F. Kennedy Jr. has called into question the safety of vaccines, arguing that they do not go through enough safety testing, including placebo testing. The American Academy of Pediatrics (AAP) released a statement ensuring that childhood vaccines are “carefully studied, including with placebos” to ensure safety and effectiveness before they are available to the public. This poll shows that parents are divided over the question of whether vaccines go through enough safety testing before being recommended for children, with many being unsure what to believe.

About four in ten (41%) parents say vaccines go through “the right amount” of safety testing in the U.S. before being recommended for children by federal health agencies, while about one-third (35%) say vaccines do not go through enough safety testing. An additional one in five parents express uncertainty, saying they are not sure whether vaccines are adequately safety tested. Very few parents overall (3%) say vaccines go through “too much” safety testing before being recommended for children.

Just as they differ on their confidence in safety, partisans differ on whether they think there is enough safety testing of vaccines, with about half (48%) of Republican parents saying there is not enough safety testing of vaccines before they are recommended for children, more than twice the share of Democratic (20%) parents who say the same. Republican parents are not a monolith, as those who say they support the Make America Great Again (MAGA) movement are more likely than Republicans who do not to say there is not enough testing (57% vs. 32%).

Views on the adequacy of safety testing for childhood vaccines also differ by age, with about four in ten (39%) parents under age 35 and about one-third (35%) of those ages 35 to 49 saying there is not enough safety testing compared to fewer parents ages 50 and older (26%).

Many Parents Are Unsure Whether Vaccines for Kids Go Through Enough Safety Testing; Younger and MAGA Republican Parents More Likely To Say They Do Not

Earlier this summer, Secretary Kennedy took a step towards changing vaccine policy in the U.S. by firing the President Biden-appointed ACIP and rebuilding it with the goal to review the current vaccine schedule for children. Secretary Kennedy himself and some of the members of the new committee have raised doubts about the current number of vaccines in the schedule, questioning whether the interactions between vaccines are safe for children. However, clinical studies have shown the current vaccine schedule and getting multiple doses when age appropriate to be safe.

About half (52%) of parents say the CDC currently recommends “about the right amount” of childhood vaccines, while a quarter say the CDC recommends “too many” childhood vaccines (26%). One in six parents say they are not sure (16%), and 5% say the CDC does not recommend enough vaccines for children. A larger share of Republican parents (41%) than Democratic (9%) or independent (26%) parents say the CDC recommends “too many” vaccines, rising to about half (49%) of MAGA Republicans.

A Quarter of Parents, Including About Half of MAGA Republicans, Say the CDC Recommends Too Many Childhood Vaccines

The CDC’s current childhood immunization schedule is based on how children’s immune systems respond to vaccines at particular ages as well as their likelihood of exposure to different diseases. The CDC advises that parents follow the timing of the immunization schedule, and there is no evidence that delaying or spacing out shots for children offers better protection or reduces serious effects. Parents, however, are divided on the question of whether childhood vaccines should be spaced out, with most (57%) correctly saying there is no strong evidence that spacing out vaccines or avoiding multiple shots in one visit is healthier for children, while four in ten (41%) incorrectly say that children are healthier when their vaccines are spaced out and they don’t get multiple shots in one visit.

Half of Republican parents and four in ten (42%) independent parents incorrectly say children are healthier when their vaccines are spaced out compared to about three in ten (28%) Democrats. About half (47%) of Black parents and about four in ten Hispanic (42%) and White (39%) parents hold this misconception.

About Four in Ten Parents Incorrectly Say Children Are Healthier When They Space Out Vaccines and Don't Get Multiple Shots at the Same Time

How Parents Identify Themselves When It Comes to Vaccine Views

While many parents express at least some level of concern or uncertainty about vaccine safety, very few (6%) say they consider themselves “anti-vaccine.” Similar shares of parents identify as either “pro-vaccine” (48%) or “somewhere in the middle” (45%). Six in ten Republican parents (57%), including six in ten MAGA Republicans and about half (52%) non-MAGA Republicans, say they are “somewhere in the middle” when it comes to vaccine attitudes. Most (70%) Democratic parents say they are “pro-vaccine.” White parents are more likely to be “pro-vaccine” than Black or Hispanic parents (51% v. 34% v. 43% respectively), while larger shares of Black parents (51%) and Hispanic parents (50%) say they are “somewhere in the middle.”

While anti-vaccine parents express vaccine skeptic views on other questions, and pro-vaccine parents are generally accepting and confident in vaccines, parents who identify as “somewhere in the middle” hold mixed views. For example, few “pro-vaccine” parents (17%) say childhood vaccines do not go through enough safety testing compared to much larger shares of parents who consider themselves anti-vaccine (64%) or somewhere in the middle (51%).

Across Groups, Few Parents Identify As Anti-Vaccine, With Most Saying They Are Pro-Vaccine or Somewhere in the Middle

Skipping and Delaying Childhood Vaccines: Which Parents Do It and Why?

As large shares of parents express positive attitudes towards childhood vaccines, most parents also report keeping their children up to date on childhood vaccines (84%). However, about one in six (16%) parents say they have ever skipped or delayed at least one childhood vaccine for any of their children (excluding seasonal vaccines like flu and COVID-19). Like vaccine attitudes, parents’ decisions about vaccination also differ along partisan lines. Republican parents are nearly three times as likely to report skipping vaccinations for their children compared to parents who are Democrats (22% vs. 8%). This partisan gap in parents’ reports of keeping children’s vaccinations up to date is  consistent with trends KFF polls have found since the COVID-19 pandemic led to deepening partisan divides in vaccine attitudes among all adults.

Similar to differences seen in some vaccine attitudes, younger parents are more likely than older parents to report skipping or delaying childhood vaccines. About one in five (19%) parents under age 35 report skipping or delaying vaccines for their children, regardless of the age of their child. This is larger than the shares of parents ages 35 to 49 (16%) or parents ages 50 and older (12%) who say the same.

Among White parents, religious beliefs play a role in childhood vaccine decisions. About one in five (19%) White parents overall report skipping or delaying vaccines for their children, rising to about one-third (36%) of White parents who describe themselves as “very religious.” Parents who homeschool their children are nearly four times as likely to report skipping or delaying vaccines compared to parents who have never homeschooled (46% vs. 12%).

Most Parents Report Keeping Children Up to Date on Vaccines; One in Five Young Parents, Republican Parents Report Skipping or Delaying Childhood Vaccines

About three quarters (73%) of the 6% of parents who describe themselves as “anti-vaccine” say they have skipped or delayed vaccines for their children. The vast majority (95%) of “pro-vaccine” parents have kept their children up to date with recommended vaccines. While most parents who describe themselves as “somewhere in the middle” on vaccines have kept their children up to date (78%), about one in five (22%) of these parents say they have ever skipped or delayed a childhood vaccine for their kids.

Three Quarters of Anti-Vaccine Parents Have Skipped or Delayed Vaccines for Their Kids, As Have One in Five Parents Who Are "Somewhere in the Middle" on Vaccines

When asked which specific childhood vaccines they have skipped or delayed, similar shares of parents report skipping or delaying the MMR vaccine (4% skipped, 5% delayed), DTaP (4% skipped and 5% delayed), hepatitis B (5% skipped and 4% delayed), chickenpox (4% skipped and 4% delayed), and polio (3% skipped and 4% delayed) vaccines. While just 6% of parents say they have skipped or delayed all the vaccines asked about in this poll, one in ten (10%) say they have skipped or delayed at least 2 childhood vaccines for their children, and 8% have skipped or delayed at least three. Overall, 8% of parents report delaying at least one of these vaccines, while 7% report forgoing at least one vaccine entirely.

Similar Shares of Parents Report Skipping or Delaying Different Childhood Vaccines

Parents’ reasons for skipping or delaying vaccines for their own children mirror many of the general concerns and uncertainty expressed by parents overall. About two-thirds (67%) of parents who skipped or delayed vaccines for their child say concerns about side effects were a “major reason” for their decision. About half of these parents say not trusting that vaccines are safe (53%) or not thinking all the recommended vaccines are necessary (51%) are major reasons they skipped or delayed their child’s vaccines.

About four in ten (42%) parents who skipped or delayed vaccines for their child say not wanting their child to get multiple shots at once was the major reason, followed by about one-third (34%) who say they skipped or delayed vaccines because they can keep their child healthy in other ways without vaccines. About one in ten parents who skipped or delayed vaccines say the major reason was that their child is afraid of needles (10%) or their doctor did not recommend vaccination (9%).

Few vaccine-skipping parents cite access reasons, such as not having time or not being able to get an appointment (9%) or that the cost was too high (5%). One in eight (13%) parents say a major reason they skipped or delayed vaccines for their child was that their child has a health condition, while one in eight (13%) say this was a minor reason and nearly three in four (72%) parents who skipped vaccines say a medical condition was not a reason for skipping vaccines for their child.

Half or More Parents Who Skipped or Delayed Vaccines for Their Children Cite Side Effects, Safety Concerns, or Claim Not All Vaccines Were Necessary

Half of parents who delayed or skipped vaccines for their children say their child’s health care provider was supportive of their decision (49%), while one in five say their doctor was not supportive (23%) and about one in four (27%) say they did not discuss the decision with a health care provider. Similar shares of parents across age groups and with children in different age cohorts say their doctor was supportive of their decision to delay or skip vaccines.

Half of Parents Who Skipped Vaccines For their Children Say Their Child's Doctor Was Supportive of the Decision; About One Quarter Did Not Consult a Doctor

Some parents may be self-selecting pediatricians who align with their vaccine views. One in four parents who have skipped or delayed vaccines for their children say they have ever changed or tried to change their child’s provider due to the provider’s views on vaccines. Few (3%) parents who keep their children up to date on vaccines say the same.

One in Four Parents Who Skipped or Delayed Vaccines for Their Kids Say They Tried To Change Pediatricians Due to Provider’s Vaccine Views

Few parents report feeling pressured by peers or doctors to vaccinate their children, though those who have skipped or delayed vaccines are more likely to report feeling pressure. About one in four (23%) parents overall say they have felt unfairly pressured by government health agencies to vaccinate their children, rising to about half (49%) among parents who have skipped or delayed vaccines. Smaller shares say they have felt pressure from a health care provider (16% overall, 44% among parents who skipped or delayed vaccines), their child’s school or daycare (14% overall, 32% among parents who skipped or delayed vaccines), friends or family (10% overall, 24% among parents who skipped or delayed vaccines), or other parents (10% overall, 26% among parents who skipped or delayed vaccines). Few parents who report keeping their children up to date on vaccines report feeling pressure from these sources.

At Least Four in Ten Parents Who Skipped or Delayed Vaccines Say They Felt Unfairly Pressured by a Doctor, Gov. Health Agency to Vaccinate Their Kids

The Role of Schools

At this time, all 50 states and D.C. have state laws that require children starting school to be vaccinated against MMR and polio at the federally recommended ages, though Florida has announced that the state will end all vaccine mandates, including for school children. While there is no federal law regarding childhood vaccinations, recommendations about school requirements are issued by the CDC’s Advisory Committee on Immunization Practices (ACIP). Each state has its own laws determining school vaccination requirements, including policies for exemptions. While all states allow for medical exemptions from school vaccine requirements, some states additionally allow for religious or other personal-belief exemptions.

Overall, parents largely support these policies, with about eight in ten (81%) parents saying public schools should require vaccines for measles and polio with some exceptions, while about one in five (18%) say public schools should not require measles and polio vaccines for any students. While Republican parents and independents are each more likely than Democrats to say public schools should not require these vaccines, majorities across these groups nonetheless support such requirements.

Most Parents Support Public School Vaccine Requirements for Measles and Polio, While About One in Five Say Public Schools Should Not Require These Vaccines

Eight percent of parents overall, including about one in four (27%) of those who have skipped or delayed vaccines, say they have applied for an exemption so their child could attend school or daycare without receiving required vaccines. The most common type of exemption is for personal reasons, reported by 4% of parents overall and one in five parents who have skipped or delayed any vaccinations for their children. Religious reasons for exemption are cited by 4% of parents overall, and one in six (16%) parents who have skipped or delayed vaccinations for their children. Medical exemptions are least common, reported by 3% of parents overall and one in ten (11%) parents who have skipped vaccines for their children.

About two-thirds (64%) of parents who applied say their exemption was approved, while 36% say it was denied. Among all parents, 5% say they applied for an exemption, and it was granted and 3% say they applied and were denied. In a policy statement, the American Academy of Pediatrics (AAP) “advocates for the elimination of nonmedical exemption from immunizations” citing their role in increasing the risk of measles and other vaccine preventable disease outbreaks.

One in Ten Parents Who Have Skipped or Delayed Vaccines Say They Have Applied for a Medical Exemption for Their Child To Attend School Without Vaccinations

One in five parents of children ages 6-17, including four in ten (42%) of those who have skipped or delayed vaccinations, say they have homeschooled their child for reasons other than the COVID-19 school shutdowns. Consistent with previous polling on homeschooling by The Washington Post, vaccine requirements do not appear to be the main motivation for homeschooling for most parents. Three in ten homeschool parents say school vaccine requirements were a major (14%) or minor (16%) reason for homeschooling their child, while seven in ten (69%) say school vaccine policies were not a reason. One in five parents who currently or previously homeschooled their children say they applied for a school vaccine exemption at some point.

Parents’ Views of the HPV Vaccine

Introduced in 2006, vaccines for human papillomavirus (HPV) prevention have been the source of some controversy. HPV is a sexually transmitted infection (STI) that can cause cervical cancer and other cancers. The HPV vaccines available in the U.S. have been clinically proven to be safe and effective at preventing HPV-related infections and cancers. Children can be vaccinated for HPV as young as 9 in some states, though the CDC recommends routine vaccination against HPV between ages 11 and 15. While health experts broadly recommend the vaccine for adolescents and children before an exposure to HPV, its connection to STIs has fueled debate over whether it should be given to children. About two-thirds of parents (64%) say they have heard “a lot” (22%) or “some” (41%) of the vaccine that prevents HPV, including similar shares of parents of girls and boys.

About six in ten (62%) parents of children ages 9 and older say their child has already received the HPV vaccine, or they probably or definitely will get it. This rises to about seven in ten (69%) among parents who have kept all their children up to date on other childhood vaccines. As with vaccine uptake for other childhood vaccines, Democratic parents (76%) are more likely to say their child will get or has gotten vaccinated against HPV, though half (51%) of Republican parents of eligible children say the same. About six in ten (62%) independent parents say they have gotten their child vaccinated against HPV or plan to do so. Similar shares of parents of boys and girls say they have gotten or will get their older children vaccinated.

Six in Ten Parents of Children Ages 9 and Older Say Their Child Has Already Gotten or Will Get Vaccinated Against HPV

Among parents of children under age 9 who are not yet eligible for HPV vaccination, about six in ten say they will definitely (29%) or probably (29%) get their child vaccinated against HPV, while one in five say they probably (9%) or definitely (10%) will not vaccinate their child. One in five (22%) are not sure. Larger shares of Democratic parents (79%) and parents who have not skipped any childhood vaccines for their children (66%) say they will probably or definitely get their children vaccinated against HPV when they are eligible, compared with about four in ten (42%) Republican parents and one in five (19%) of those who have skipped or delayed childhood vaccines.

Six in Ten Parents of Young Children Say They Will Probably or Definitely Get Them Vaccinated Against HPV When They Are Eligible; One in Five Are Not Sure

In Their Own Words: Why do you think you will not get your child vaccinated against HPV?

In a follow up question, parents who said they “probably” or “definitely” would not get their child vaccinated against HPV told us why that is. Many offered responses related to concerns about the HPV vaccine being associated with unsafe sexual behavior and did not see a need to give that to their children, as well as anecdotes of side effects.

“Risks outweigh the benefits. This is a disease caused by a virus you get due to unwise behavior.” – Republican parent of a teenage boy and girl, age 51, Wisconsin

“They should not be engaging in sexual activity until marriage, and they explicitly understand the risks without the vaccine, and of course, the sinful nature.” – Independent parent of a pre-teen girl, age 34, Pennsylvania

“[I] know someone who had a vaccine injury from the vaccine and because it is a newer vaccine unsure of effectiveness and risk of long-term complications.” – Republican parent of a teenage girl, age 38, Louisiana

“Children should not be having a sexual relationship and being exposed to disease.” – Republican parent of a teenage boy, age 54, Pennsylvania

“I have personally known multiple people with severely adverse health effects directly caused by that vaccine. It also sends a message to our children that we expect them to be sexually immoral. It appears to have been more of a money grab than an actually useful vaccine.” – Independent parent of a teenage boy, age 43, Florida

“I’ve seen mixed information about the vaccine not just from parents. I would like to do further research about the potential adverse effects and benefits before making a decision.” – Democratic parent of pre-teen girls, age 41, Texas

Belief in False and Misleading Claims About Measles and Vaccines

Before his confirmation and in his role as HHS Secretary, Robert F. Kennedy Jr. has amplified claims about vaccines that have been rejected by scientists and public health officials. Along with firing and reassembling the ACIP, Kennedy has said he will investigate the childhood vaccination schedule, suggesting without evidence that the number of recommended childhood vaccines has led to a rise in chronic disease in the U.S. Kennedy has also repeated false claims that vaccines, including MMR, can cause autism and that the measles vaccine causes the illness it prevents. More recently, Kennedy has promoted Vitamin A as an effective treatment for measles, despite public health experts’ warning that supplements cannot substitute for vaccination.

Relatively few parents think false or misleading claims about vaccines and measles are true, but many are uncertain, with at least four in ten saying they do not know enough to say. At the same time, the share who say these false claims are true is higher among Republican parents, particularly those who identify as supporters of the Make America Great Again (MAGA) movement.

Overall, few parents say they think it is true that chronic diseases are rising because of an increase in the number of vaccines children get (13%), that MMR vaccines can cause autism in children (9%), that the measles vaccine causes the same illness it is supposed to prevent (8%), or that vitamin A is an effective treatment for measles (6%). For each of claim related to vaccines,  between four in ten and half say they are false, including that the measles vaccines cause the same illness they are supposed to prevent (49%), that chronic disease are likely rising due to an increase in the number of childhood vaccines (45%), or that MMR vaccines can cause autism in children (42%).  Assessing the false claim that Vitamin A is an effective treatment for measles, about one in four correctly say it is false (27%), while two-thirds (66%) say they do not know enough to say.

Few Adults Say They Think False Statements About Vaccines and Measles are True, But At Least Four In Ten Express Uncertainty

Republican parents are about twice as likely as Democratic parents to believe that chronic diseases are rising because of an increase in the number of vaccines children get (18% v. 7%) and that the MMR vaccines can cause autism in children (13% v. 5%). Belief in each of the three claims related to vaccines and measles is higher among parents who are MAGA Republicans compared to non-MAGA Republicans; nonetheless, most MAGA supporters either express uncertainty or say these claims are false.

Parents who say they skipped or delayed recommended vaccines for their children are far more likely than those who have kept their children up to date to believe these myths.

MAGA Republican Parents and Parents Who Have Skipped or Delayed Children's Vaccines Are More Likely To Believe False Claims About Vaccines

The claim linking MMR vaccines to autism is one that has a long history, and previous KFF polling has found many parents are uncertain about the facts around autism and vaccines. The poll finds that parents who say their child has been diagnosed with autism spectrum disorder are more likely than those whose children have not to say it is true that MMR vaccines can cause autism in children (16% v. 9%). About one-third (37%) of parents of children diagnosed with autism say they do not know enough to answer.  

About Half of Parents of Kids Diagnosed With Autism Correctly Say it is False That MMR Vaccines Cause Autism, Nearly Four in Ten Are Unsure

Confidence in Federal Health Agencies and Changes to Vaccine Policy

Amid criticism of federal health agencies, Robert F. Kennedy Jr. was appointed HHS Secretary, and said his priority was to strengthen the agencies’ independence and base decisions on scientific evidence. Six months into his term as Secretary, parents’ confidence in federal health agencies to carry out some of their core functions is mixed.

About half (49%) of parents say they have “a lot” or “some confidence” in government health agencies like the CDC and FDA to ensure the safety and effectiveness of vaccines. Fewer than half express confidence in these agencies to make decisions based on science rather than the views of agency officials (40%) or to act independently without interference from outside interests (35%).

Half or Fewer Parents Are Confident in Federal Health Agencies To Ensure Vaccine Safety, Follow Science, or Act Independently

Republican parents are less likely than Democratic parents to express confidence in government health agencies to ensure the safety and effectiveness of vaccines (41% v. 60%), make decisions based on science rather than the views of agency officials (35% v. 48%), or to act independently without outside interference (30% v. 40%).

Even among parents who are ostensibly among the current administration’s most ardent supporters (Republicans who say they support the MAGA movement), fewer than half express at least some confidence in federal government health agencies to ensure the safety and effectiveness of vaccines, make decisions based on science, or act independently.

Parents under age 50, who are more likely to express vaccine-skeptical attitudes and to report skipping or delaying vaccines for their children, are less likely than older parents to express confidence in government health agencies to ensure vaccine safety and effectiveness and to act independently without outside interests.

Confidence in Federal Health Agencies to Ensure Vaccine Safety is Lower Among Younger Parents, MAGA Republican Parents

Since his appointment as Secretary of Health and Human Services, Robert F. Kennedy Jr. has made several changes to U.S. vaccine policy, including replacing the ACIP, removing COVID-19 vaccine recommendations for healthy children, and cancelling funding for mRNA vaccine research. This survey, fielded late July to early August 2025, finds that fewer than half of parents have heard about these changes.

About four in ten (38%) parents have heard “a lot” (11%) or “some” (27%) about recent changes Kennedy has made that could affect vaccine policies in the U.S., while about one in four (27%) have heard “a little” and one-third (34%) have heard “nothing at all.” Parents with a college degree (49%) and Democrats (49%) are more likely than their counterparts to say they have heard at least “some” about these recent changes.

A Majority of Parents Have Heard Little or Nothing About Kennedy's Changes That Could Impact Vaccine Policy in the U.S.

When it comes to expectations of the impact of these changes, parents are split along party lines. One in six parents (16%) say the changes made by Kennedy will make childhood vaccines safer, about one in five (18%) say the changes will make childhood vaccines less safe, and an additional one in five say these changes will not make a difference (22%). The largest share of parents, more than four in ten (44%), say they are not sure how these changes will impact safety.

Partisans are split, with about three in ten (29%) Republican parents, rising to nearly four in ten (38%) MAGA Republicans, saying these changes will make childhood vaccines safer, compared to 4% of Democratic parents. Four in ten Democratic parents and 5% of Republican parents say the changes will make vaccines less safe. About one in five parents across partisans say the changes will not make a difference, and at least one-third say they are not sure.

Parents Are Divided Over Whether Kennedy's Changes Will Make Childhood Vaccines Safer or Less Safe; Four in Ten Are Not Sure

Fewer than one in ten (8%) parents say that changes made by Kennedy will make it easier for parents to access vaccines for their children, about one in four (24%) say these changes will make it more difficult, and about one in four say it will not make a difference (23%). The largest share (44%) say they are not sure.

Again, partisans are split, with half of Democratic parents (52%) saying Kennedy’s changes will make it more difficult to access vaccines. Most Republican parents say Kennedy’s changes will not make a difference in access to childhood vaccines (33%) or that they are not sure (46%).

About Half of Democrats Say Kennedy’s Changes Will Make Vaccine Access Difficult; Most Republicans See No Impact or Are Unsure

Secretary Kennedy has promised radical transparency and a decrease in the pharmaceutical industry’s influence on U.S. vaccine policy, yet about half (51%) of parents are unsure whether Kennedy’s policies will achieve this decreased influence. One in five (20%) say Kennedy’s changes will decrease pharmaceutical company influence in U.S. vaccine policy, about one in ten (11%) say they will increase influence, and one in six (17%) parents say it won’t make a difference.

Half of Republicans (47%) and Democrats (50%) say they are not sure if Kennedy’s changes will increase or decrease pharmaceutical company influence in U.S. vaccine policy. One-third (32%) of Republicans expect the changes to decrease pharmaceutical company influence, while one in five Democrats say it will either increase (18%), or will not make a difference (20%).

Half of Parents Are Unsure How Kennedy's Changes Will Impact Pharmaceutical Influence in U.S. Vaccine Policy; Republicans More Likely to Say it Will Decrease

Methodology

This KFF/The Washington Post Survey of Parents was designed and analyzed by public opinion researchers at KFF and The Washington Post. The survey was designed to reach a representative sample of parents or legal guardians of children under the age of 18 in the U.S. The survey was conducted July 18 – August 4, 2025, online among a nationally representative sample of 2,716 parents using the Ipsos KnowledgePanel in English (n=2519) and in Spanish (n=197). KnowledgePanel is a nationally representative probability-based panel where panel members are recruited randomly through invitations mailed to respondents randomly sampled from an Address-Based Sample (ABS) provided by Marketing Systems Groups (MSG) through the U.S. Postal Service’s Computerized Delivery Sequence (CDS). Invitations were sent to panel members by email followed by up to two reminder emails.

All completes were reviewed to ensure respondents were giving the survey adequate attention. Three cases were removed from the data that failed internal quality checks. Most KnowledgePanel respondents received a financial incentive equaling about $1 for their participation in this survey with some harder-to-reach groups receiving about $5 for their participation.

The survey also includes an oversample of parents of children 5 years old and younger (n=1,092) in order to reach a higher rate of responses from parents who are currently making decisions around their child’s vaccines. The full sample was weighted to match the sample’s demographics to the national U.S. parent population using data from the Census Bureau’s 2023 American Community Survey. Weighting parameters included gender, age, education, race/ethnicity, region, metro status, and language proficiency within the Hispanic sample. The sample was also weighted to the total parent population on political party identification using the 2025 KFF Benchmarking Survey.  An additional adjustment was conducted in order to provide estimates from parents living in Texas (n=276) using the 2023 ACS as well as the 2023-2024 Pew Religious Landscape Survey. Both weights take into account differences in the probability of selection, including adjustment for the sample design, within household probability of selection, and the design of the panel-recruitment procedure.

The margin of sampling error including the design effect for the total sample is plus or minus 2 percentage points and plus or minus 3 percentage points for the parents of children under the age of 6. The full Texas sample has a margin of sampling error of plus or minus 7 percentage points. Numbers of respondents and margins of sampling error for key subgroups are shown in the table below. For results based on other subgroups, the margin of sampling error may be higher. Sample sizes and margins of sampling error for other subgroups are available on request. Sampling error is only one of many potential sources of error and there may be other unmeasured error in this or any other public opinion poll. KFF and The Washington Post are charter members of the Transparency Initiative of the American Association for Public Opinion Research.

M.O.S.E.N (unweighted)M.O.S.E.
Total parents2,716± 2 percentage points
Texas parents276± 7 percentage points
Florida parents136± 9 percentage points
   
Party ID  
Democratic parents                                                                                           801± 4 percentage points
Independent/Other party parents1,077± 3 percentage points
Republican parents780± 4 percentage points
MAGA Republican parents498± 5 percentage points
   
Parents by vaccine choice  
Skipped or delayed any childhood vaccines436± 5 percentage points
Kept kids up to date on all childhood vaccines2,264± 2 percentage points

 

 

Status of State Medicaid Expansion Decisions

Published: Sep 12, 2025

The Affordable Care Act’s (ACA) Medicaid expansion expanded Medicaid coverage to nearly all adults with incomes up to 138% of the Federal Poverty Level ($21,597 for an individual in 2025) and provided states with an enhanced federal matching rate (FMAP) for their expansion populations.

To date, 41 states (including DC)   have adopted   the Medicaid expansion and 10 states   have not adopted   the expansion. Current status for each state is based on KFF tracking and analysis of state expansion activity.

These data are also available in a table format. The map may be downloaded as a Powerpoint.

Status of State Action on the Medicaid Expansion Decision
Key States with Expansion Activity

Medicaid Expansion Resources

A Look at Recent Changes to State Vaccine Requirements for School Children

Published: Sep 12, 2025

Routine vaccination rates for kindergarten children have declined since the COVID-19 pandemic began, while exemptions from school vaccination requirements, particularly non-medical exemptions, have increased. These trends coincide with shifting attitudes toward childhood vaccination likely fueled in part by vaccine misinformation. The past few years have seen more skepticism and confusion among the public about the safety and effectiveness of vaccines, a decline in trust of health authorities, and a growing partisan divide. Shifts in vaccine attitudes are reflected in recent state level policy changes, with state lawmakers introducing more than 2,500 vaccine-related bills since 2021, with almost half targeting vaccine requirements. In addition, Florida officials recently announced plans to eliminate all school vaccination requirements. Despite these changes, recent KFF polling found that public confidence in the safety of routine vaccines like MMR remains high and about eight in ten (81%) parents overall as well as large majorities of parents who identify as Democrats, independents, and Republicans support current state vaccine requirements, saying students should be required to be vaccinated against measles and polio to attend public schools with some exceptions. This policy watch examines recent state policy changes to school vaccine requirements and the extent to which they may impact vaccination trends.

States and local jurisdictions, not the federal government, set vaccine requirements for daycare and school entry. The federal government does, however, have a long-standing, evidence-based system for approving and recommending vaccines for the public, including the childhood vaccination schedule. The childhood vaccination schedule is set by the Centers for Disease Control and Prevention (CDC) based on recommendations from the Advisory Committee on Immunization Practices (ACIP). ACIP’s recommendations are used by many states to develop school vaccine requirements. HHS Secretary Robert F. Kennedy Jr. (RFK Jr.), who has long record of opposing immunizations and spreading vaccine misinformation, has led recent efforts to re-examine the federal childhood vaccine schedule, replace members of ACIP, and restrict COVID-19 vaccines and mRNA vaccine research. In addition, the Trump administration recently released a report that calls for a new vaccine framework that includes reevaluating the childhood vaccine schedule and addressing vaccine injuries.

All states currently require children to be vaccinated against certain diseases in order to attend public schools. School vaccination requirements are an important tool for reducing the spread of diseases and increasing vaccination coverage rates. Required vaccinations across every state and D.C. include MMR, DTaP, polio, and varicella; some states also require hepatitis A, hepatitis B, meningococcal, and/or HPV vaccines. At this time, no states require the COVID-19 vaccine for school entry. While it has yet to be enacted, Florida’s plan to eliminate all school vaccination requirements would make them the first and only state to do so. However, as the divide between red and blue states on health policy grows, more states may consider moving this direction.

All states allow exemptions from school vaccination requirements for medical reasons and almost all states (47 including D.C.) allow exemptions for religious and/or personal beliefs (Figure 1). This leaves four states (California, Connecticut, Maine, and New York) that only allow medical exemptions. Studies have shown that higher exemption rates from school vaccination requirements are associated with lower vaccination coverage rates and increased risk for disease outbreaks. In the 2024-2025 school year, the share of children claiming an exemption from vaccination requirements from one or more vaccinations rose to 3.6%, the highest national exemption rate to date, up from 2.5% in 2019-2020. Increases in non-medical exemptions accounted for the recent increases, with non-medical exemptions increasing from 2.2% to 3.4% over the period. Vaccination rates and exemption rates vary significantly by state, with the share of children claiming an exemption from one or more vaccinations during the 2024-2025 school year ranging from 0.1% in California to 15.4% in Idaho.

47 States Allow Exemptions From School Vaccination Requirements for Religious and/or Personal Beliefs

At least 10 states so far this year have enacted or issued changes related to routine vaccine requirements for children (Table 1). In the years following the pandemic, states saw an increase in vaccine-related policy proposals. The pandemic spurred increased state legislative activity initially focused on state-level authority to require COVID-19 vaccines. However, over time, as the response to COVID-19 became more politicized, states began limiting COVID-19 vaccine mandates as well as focusing more broadly on routine vaccination requirements (and exemptions to those requirements) in schools. Notably, most of the vaccine-related bills introduced by legislators since the pandemic began have not passed, but ten states in the past year have enacted or issued policy changes related to school or child care vaccination requirements.

Almost all states (nine out of 10 states with recent changes) made changes that could result in more students claiming a non-medical exemption, which could reduce vaccination rates. Many of the recent changes (described in Table 1) will make it easier for families with children in childcare settings or school to obtain a non-medical vaccine exemption. Notably, the governor of West Virginia signed an executive order allowing religious and personal belief exemptions in January 2025, though litigation is ongoing. Prior to 2025, West Virginia was one of five states (now four states) that only allowed medical exemptions and had the highest vaccination rates and lowest exemption rates in the country during the 2023-2024 school year (the latest available data for the state). In addition, Idaho, the state with the lowest vaccination rates and highest exemption rates during the 2024-2025 school year, transferred control of required vaccines to the legislature and restricted medical mandates (likely weakening school vaccine requirement enforcement). These changes, in addition to broader state efforts to scale back immunization outreach and promotion, changes to vaccine recommendations at the federal level, and reduced support from the federal government for state and local health departments, could further increase the number of exemptions requested and drive down vaccination rates among children. Florida’s plan to eliminate all school vaccination requirements goes beyond expanding exemptions and would mark a major shift in state vaccination requirements, though the issue will have to be taken up by the state legislature.

At the same time, one state has made a change that could maintain or increase children’s routine vaccination rates. Colorado recently passed a law allowing the consideration of vaccine recommendations from outside groups like the American Academy of Pediatrics (AAP), not only ACIP, when developing school vaccine requirements. More states may move in this direction depending on the outcome of ACIP’s upcoming meeting on vaccine recommendations and potential further changes by RFK Jr. to the ACIP panel. In addition, the AAP also recently reaffirmed their support for eliminating non-medical exemptions amid rising exemption rates, and some states, such as Massachusetts and Hawaii, are proposing eliminating non-medical exemptions, though these changes have not been enacted. While the appointment of RFK Jr. in early 2025 likely spurred additional efforts to loosen vaccine requirements in many states this year, other states are working to ensure vaccine access amid changes at the federal level.

At Least 10 States So Far This Year Have Enacted or Issued Changes Related to Routine Vaccine Requirements for Children

The Landscape of School-Based Mental Health Services

Published: Sep 11, 2025

Editorial Note

This analysis, originally published on September 6, 2022, was updated on September 11, 2025 to incorporate the latest developments and data.

Nearly one in five students attending public schools in the United States utilize school-based mental health services, underscoring how schools can serve as an access point for mental health treatment among youth. Federal policy measures, including the Bipartisan Safer Communities Act, the American Rescue Plan Act, and changes to Medicaid guidance, provided pathways to expanding and improving access to school-based services. However, recent actions – such as cuts to the Department of Education, the freezing of $1 billion allocated for school-based mental health services, and major reductions to Medicaid – may cause disruptions. Some school programs have already reported concerns with providing mental health services in the wake of these recent actions, including programs in New York, North Carolina, and Texas. These disruptions come at a time when approximately 1 in 5 teens are experiencing symptoms of anxiety or depression and many youth have reported bullying and exposure to violence, which can have adverse effects on their mental health. Additionally, a 2024 KFF survey found differences in receipt of mental health care services by race and ethnicity, with a larger share of White parents compared to Black, Hispanic, and Asian parents reporting that their children received these services in the past three years.  

This issue brief explores the landscape of mental health services, including services offered, utilization, barriers, and funding, and how recent federal actions may affect school-based mental health care. This analysis draws upon survey data collected directly from public school administrators via the School Pulse Panel,1 a study by the National Center for Education Statistics and the U.S. Census Bureau that surveys schools monthly on a variety of topics, including school mental health services. Key Findings include:

  • In the 2024-2025 school year, 18% of students utilized school-based mental health services.
  • About one-third of schools reported they strongly (11%) or moderately disagreed (25%) that they could effectively provide mental health services. Barriers to providing mental health care services to students include funding and mental health provider shortages.
  • Ninety-seven percent of schools provide at least one mental health service to students. In recent years, larger shares of these schools provide services via telehealth, and provide group-based and family interventions.
  • Seventy percent of public schools that provide mental health services had a school or district-employed licensed mental health professional on staff and 57% employed an external mental health provider.
  • Thirteen percent of schools did not have mental health services available for staff in the 2024-2025 school year.

Background

School-based mental health services can improve access to care, allow for early identification and treatment of mental health issues, and may be linked to reduced absenteeism and better mental health and substance use outcomes. School-based services can also reduce access barriers for underserved populations, including children from low-income households and children of color.

The delivery of mental health services in schools has evolved over time and continues to vary across schools. Some students access in-person mental health services at schools or near campus while others access services through telehealth. Service delivery can range from a single provider (who is not necessarily a licensed mental health professional) to a team of providers, including psychologists, social workers, and academic or guidance counselors. A growing number of schools have also integrated social and emotional learning and other mental health literacy programs into their curriculum.

Schools receive support for providing mental health services in several ways. This includes support at the federal level through the Department of Education and the Department of Health and Human Services. A recent federal measure, the Bipartisan Safer Communities Act (BSCA) of 2022, included provisions to support and expand school-based mental health services, such as $1 billion to increase the number of mental health providers in schools and provide training. However, in April 2025, under the Trump Administration, the Department of Education announced the cancellation of these funds. Additionally, President Trump signed an executive order in March 2025 to dismantle the Department of Education, an entity which has developed guidance regarding school-based health services in partnership with Medicaid and provides resources and grants to support mental health, anti-bullying, and trauma-prevention interventions in schools.

Schools can also receive support through Medicaid, including reimbursement for medically necessary services that are part of a student’s Individualized Education Plan (IEP), reimbursement for eligible health services for students with Medicaid coverage and for some administrative services. In 2022 and 2023, CMS issued guidance to increase the accessibility of these services by eliminating some of the practical barriers that schools faced when delivering services through Medicaid. However, significant changes to Medicaid, including budget cuts, in the reconciliation bill passed in July 2025 may impact how Medicaid can support school services in the future. In 2023, nearly four in ten children in the U.S. had Medicaid coverage.

What Share of Students Utilize School-Based Mental Health Services?

In the 2024-2025 school year, public schools reported that on average 18% of students utilized school-based mental health services. Additionally, 58% of schools reported that the number of students who sought school-based mental health services increased since the prior school year. Similarly, there was a 61% increase from the 2023-2024 school year to the 2024-2025 school year in concerns expressed by staff about students exhibiting depression, anxiety, trauma, or emotional dysregulation/disturbance.

What Have Schools Said About Their Ability To Provide Mental Health Services To Students?

In the 2024-2025 school year, approximately half of public schools reported they could effectively provide mental health services to all students in need. This includes 10% of schools that say they strongly agree they could effectively provide mental health service and 42% that moderately agreed. Meanwhile, about one-third of schools reported they strongly (11%) or moderately disagreed (25%) that they could effectively provide mental health services and 11% neither agreed or disagreed. These shares have remained mostly similar since survey data collection began in the 2021-2022 school year.

Among the schools that did not strongly believe they could effectively provide mental health services to students in need, inadequate funding and mental health provider shortages have remained the most frequently reported limitations since the 2021-2022 school year (Figure 1).

Interactive DataWrapper Embed

However, the share reporting inadequate funding has increased over time (from 47% in 2021-2022 to 56% in 2024-2025), while the share reporting insufficient mental health staff coverage and access to licensed professionals has slightly decreased over the same period (from 61% to 55% and from 57% to 51%, respectively). These changes may reflect recent federal efforts to increase the number of school mental health professionals but also the end of federal pandemic-era funds. Further, many schools continue to not meet recommended ratios for psychologists to students (500:1) or counselors to students (250:1). Among schools with staffing vacancies in the 2024-2025 school year, 28% of public school administrators feel they are understaffed with mental health providers.

What Mental Health Services Are Offered to Students?

In the 2024-2025 school year, 97% of public schools reported offering at least one type of mental health service to their students. As shown in Figure 2, the most frequently offered services are:

  • Individual-based intervention like one-on-one counseling or therapy (83% of public schools)
  • Case management or coordinating mental health services (70%), and
  • Referrals for care outside of the school (67%).

The use of telehealth to deliver mental health treatment has increased from 17% to 22% between the 2021-2022 and 2024-2025 school years. While telehealth became a more widely used pathway to delivering health care since the pandemic, a growing number of schools were already providing care through telehealth prior to the pandemic.

Group-based interventions increased between the 2021-2022 and 2024-2025 school year (from 56% to 65%), as well as family interventions (from 38% to 43%).

Interactive DataWrapper Embed

Only about one-third of schools provide outreach services, which includes mental health screenings for all students. These universal behavioral health screenings are considered a best practice and allow for schools to better identify all students with needs and tailor services to their specific student population. However, many schools do not offer these screenings often due to a lack of resources or difficulty accessing providers to conduct screenings, burden of collecting and maintaining data, and/or a lack of buy-in from school administrators.

Who Provides Mental Health Services in Schools?

Staffing models for school-based mental health care can vary across schools. In the 2024-2025 academic year, 76% of public schools that provide mental health services had two or more types of mental health providers while 24% have one type of provider. In the same year, 70% of these public schools had a school or district-employed licensed mental health professional on staff and 57% had an external mental health provider (Figure 3).

Interactive DataWrapper Embed

Between the 2021-2022 and 2024-2025 school years, there was a decrease in the share of public schools reporting that school counselors (from 83% to 73%) or school nurses (from 25% to 16%) provided mental health services to students (Figure 3). These decreases may be reflective of schools expanding their mental health teams in recent years so that they are less reliant on general counselors and medical staff. While general or academic school counselors can provide mental health services to students, they are not equipped to offer long-term care.

Teachers often play a role in identifying students with mental health needs and linking them to care, although prior research suggests  that many teachers may not be adequately trained to do so. In the 2024-2025 school year, 61% of schools reported providing trainings and professional development to staff in order to help them support the emotional and mental health of school students. Data on the impact of these trainings is unavailable and it is unclear what share of schools provided trainings in the years prior.

How Do Schools Receive Funding For The Mental Health Services They Provide?

School mental health services are supported through multiple sources of funding at the national, state, and local level. In recent years, a growing share of public schools reported receiving funding for mental health services from district or school funds (from 58% in 2021-2022 to 65% in 2024-2025) or partnerships with organizations (from 38% in 2021-2022 to 44% in 2024-2025) (Figure 4). Note that the School Pulse Panel survey questionnaire does not specify which funds are from Medicaid.

Interactive DataWrapper Embed

The share of public schools receiving funding from federal grants or programs has decreased from 53% in 2021-2022 to 33% in 2024-2025. This change may be due to the cessation of pandemic-era relief funds, like the Elementary and Secondary School Emergency Relief (ESSER) funds, which provided schools with the financial resources to address increasing concerns about student mental health. In 2022, the Bipartisan Safer Communities Act allowed for new funding sources to support school-based mental health services, however the Trump Administration froze $1 billion in funding in 2025. 

What Mental Health Services Are Available For Staff?

Teachers and other school staff play a multitude of roles, including monitoring students’ mental health and providing support as needed. Burnout, driven by anxiety, depression, and low job satisfaction is prevalent among teachers. In the 2024-2025 academic year, 36% of staff reported that they have seen an increase in staff expressing concerns about themselves or their colleagues showing signs of depression, anxiety, emotional dysregulation or trauma since the prior school year. While many schools offer mental health services for staff, 13% of schools do not (Figure 5).

Interactive DataWrapper Embed

Sasha Zitter, formerly with KFF, contributed to this analysis.

  1. The School Pulse Panel utilizes a random stratified sample of the Common Core of Data, a universe of public schools. This stratified sample includes public and public charter schools, schools with magnet programs, alternative schools, special education schools, and vocational schools. Approximately 4,000 schools were included in the sample for the 2024-2025 school year. Approximately 1,600 schools responded to the March survey – findings from this survey are included in this brief. There has been some variation in the number of schools that respond each month. While school principals are the initial point of contact to complete the survey, they may invite other school and district staff to assist with completion. Published data is weighted and adjusted to account for non-response. ↩︎

KFF Global Health Budget Summaries

Published: Sep 11, 2025

These global health budget summaries highlight key information about global health funding levels throughout the federal budget and appropriations process. Click on a fiscal year to expand the entries.

FY 2026

Senate:

August 4, 2025

House:

September 11, 2025

July 23, 2025

Request:

Administration Releases Additional Details of Fiscal Year 2026 Budget Request

June 4, 2025

White House Releases FY26 Budget Request

May 2, 2025

FY 2025

Final:

Congress passes Full-Year Continuing Resolution Bill, maintaining global health funding at prior year levels

March 18, 2025

Senate:

August 5, 2024

August 5, 2024

House:

July 9, 2024

House Appropriations Committee Approves the FY 2025 State and Foreign Operations (SFOPs) Appropriations Bill

June 12, 2024

Request:

Global Health Funding in the FY 2025 President’s Budget Request

March 12, 2024

FY 2024

Omnibus:

Global Health Funding in the FY 2024 Final Appropriations Bill

March 22, 2024

Senate:

July 28, 2023

July 21, 2023

House:

November 3, 2023

House Approves the FY 2024 State and Foreign Operations (SFOPs) Appropriations Bill

September 28, 2023

Request:

Global Health Funding in the FY 2024 President’s Budget Request

March 10, 2023

FY 2023

Omnibus:

Global Health Funding in the FY 2023 Omnibus

December 20, 2022

Senate:

Senate Appropriations Committee Releases FY23 State and Foreign Operations (SFOPs) and Labor, Health and Human Services (Labor HHS) Appropriations Bills

July 29, 2022

House:

June 29, 2022

House Appropriations Committee Releases the FY23 State and Foreign Operations (SFOPs) Appropriations Bill

June 28, 2022

Request:

White House Releases FY 2023 Budget Request

March 29, 2022

FY 2022

Omnibus:

Global Health Funding in the FY 2022 Omnibus

March 9, 2022

Senate:

Senate Appropriations Committee Releases FY 2022 State and Foreign Operations (SFOPs) and Labor Health and Human Services (Labor HHS) Appropriations Bills

October 20, 2021

House:

July 14, 2021

House Appropriations Committee Releases the FY22 State and Foreign Operations (SFOPs) Appropriations Bill

June 30, 2021

Request:

White House Releases Full FY 2022 Budget Request

June 2, 2021

FY 2021

Omnibus:

Global Health Funding in the FY 2021 Omnibus

January 8, 2021

Senate:

Senate Appropriations Committee Releases FY 2021 State and Foreign Operations (SFOPs) and Labor Health and Human Services (Labor HHS) Appropriations Bills

November 11, 2020

House:

House Appropriations Committee Approves FY 2021 Health and Human Services (HHS) Appropriations Bill

July 14, 2020

House Appropriations Committee Approves FY21 State and Foreign Operations (SFOPs) Appropriations Bill

July 9, 2020

Request:

White House Releases FY21 Budget Request

February 11, 2020

FY 2020

Omnibus:

Global Health Funding in the FY 2020 Conference Agreement

December 19, 2019

Senate:

Senate Appropriations Committee Approves FY 2020 State and Foreign Operations (SFOPs) Appropriations Bill

September 27, 2019

Senate Appropriations Committee Releases Draft FY 2020 Health and Human Services (HHS) Appropriations Bill

September 20, 2019

House:

House Passes Minibus That Includes Global Health Funding In FY 2020 State & Foreign Operations (SFOPs) and Health & Human Services (HHS)

June 20, 2019

House Appropriations Committee Approves FY 2020 State & Foreign Operations (SFOPs) Appropriations Bill

May 17, 2019

House Appropriations Committee Approves FY 2020 Health and Human Services (HHS) Appropriations Bill

May 13, 2019

Request:

White House Releases FY20 Budget Request

March 11, 2019

FY 2019

Omnibus:

FY19 Conference Agreement Released, Includes State & Foreign Operations (SFOPs) Funding

February 14, 2019

Senate:

Senate Appropriations Committee approves FY19 State & Foreign Operations (SFOPs) Appropriations Bill

June 22, 2018

House:

House Appropriations Committee approves FY19 State and Foreign Operations (SFOPs) Appropriations Bill

June 20, 2018

Request:

White House Releases FY 2019 Budget Request

February 13, 2018

FY 2018

Omnibus:

President Signs FY18 Omnibus Bill

March 22, 2018

Senate:

Senate Appropriations Committee approves FY 2018 State & Foreign Operations (SFOPs) and Health & Human Services (HHS) Appropriations Bills

September 11, 2017

House:

House Appropriations Subcommittees approve FY 2018 State & Foreign Operations (SFOPs) and Health & Human Services (HHS) Appropriations Bills

July 19, 2017

Request:

White House Releases FY18 Budget Request

May 24, 2017

U.S. Global Health Funding in Draft FY18 Budget Request

April 26, 2017

White House Releases FY18 Budget Blueprint

March 16, 2017

FY 2017

Omnibus:

Congress Releases FY17 Omnibus

May 1, 2017

House:

House Appropriations Committee approves FY 2017 State and Foreign Operations Appropriations Bill

July 13, 2016

Senate:

Senate Appropriations Committee approves FY 2017 State and Foreign Operations Appropriations Bill

June 30, 2016

Request:

White House Submits FY17 Reduction Options to Congress

March 29, 2017

White House Releases FY17 Budget Request

February 9, 2016

FY 2016

Omnibus:

Congress Releases FY16 Omnibus

December 16, 2015

Senate:

Senate Appropriations Subcommittee Approves FY 2016 State and Foreign Operations Appropriations Bill

July 8, 2015

House:

Updated: House Appropriations Committee releases FY16 Health & Human Services Appropriations Bill

June 24, 2015

House Appropriations Committee releases FY 2016 State and Foreign Operations Appropriations Bill

June 11, 2015

Request:

The U.S. Global Health Budget: Analysis of the Fiscal Year 2016 Budget Request

March 11, 2015

White House Releases FY16 Budget Request

February 2, 2015

FY 2015

Omnibus:

Congress Releases FY15 Omnibus

December 10, 2014

House:

FY15 Health & Human Services Appropriations Bill Introduced in House

September 15, 2014

House Appropriations Committee approves FY2015 State and Foreign Operations Appropriations Bill

June 24, 2014

Senate:

Senate Appropriations Committee releases FY15 Health & Human Services Appropriations Bill

July 24, 2014

Senate Appropriations Committee approves FY 2015 State and Foreign Operations Appropriations Bill

June 19, 2014

Request:

White House releases FY15 Budget Request

April 22, 2014

The U.S. Global Health Budget: Analysis of the Fiscal Year 2015 Budget Request

April 7, 2014

FY 2014

Omnibus:

FY14 Omnibus Appropriations Act Released

January 13, 2014

Senate:

Senate Appropriations Committee approves FY 2014 State and Foreign Operations Appropriations Bill

July 25, 2013

Senate Appropriations Committee approves FY14 Health & Human Services Appropriations Bill

July 11, 2013

House:

House Appropriations Committee approves FY 2014 State and Foreign Operations Appropriations Bill

July 24, 2013

Request:

U.S. Funding for Global Health: The President’s FY 2014 Budget Request

May 23, 2013

White House releases FY 2014 Budget Request

April 10, 2013

House Committee on Appropriations Approves FY 2026 Labor, Health and Human Services, Education, and Related Agencies (Labor HHS) Appropriations Bill & Accompanying Report

Published: Sep 11, 2025

The House Committee on Appropriations approved its FY 2026 Labor, Health and Human Services, Education, and Related Agencies (Labor HHS) appropriations bill, accompanying report, and amendments on September 9, 2025. While most U.S. global health funding is provided to the State Department through a separate appropriations bill, the Labor HHS appropriations bill includes funding for global health programs at the Centers for Disease Control and Prevention (CDC) as well as funding for global health research activities at the National Institutes of Health (NIH).

Global health funding amounts specified in the House FY 2026 Labor HHS appropriations bill are as follows (some amounts are not yet known):

  • Centers for Disease Control and Prevention (CDC): The bill eliminates funding for several programs at the CDC’s Center for Global Health including: 1) Global HIV/AIDS; 2) Global Tuberculosis; and 3) some global vaccination activities. [i] The bill maintains CDC’s funding at the prior year (FY 2025) level for global polio vaccination and Global Public Health Protection programs, and transfers funding for Parasitic Diseases and Malaria from the Center for Global Health to the National Center for Emerging and Zoonotic Infectious Diseases, but does not specify an amount.
  • National Institutes of Health (NIH): Funding for global health research activities at the Fogarty International Center (FIC) at NIH matches the prior year (FY 2025) amount. Funding for other global health research activities (i.e., global HIV/AIDS and malaria research) at NIH is not yet known because it is determined at the agency level rather than specified by Congress in annual appropriations bills.[ii]

See the table below for additional details on global health funding (downloadable table here). See other budget summaries and the KFF budget tracker for details on historical annual appropriations for global health programs.

KFF Analysis of Global Health Funding in the FY 2026 House Labor, Health and Human Services, Education, and Related Agencies (Labor HHS) Appropriations Bill

[i] Funding for FY25 was provided in a full-year Continuing Resolution (CR), which maintained FY24 levels. All FY25 amounts and associated notes are based on those specified in relevant FY24 appropriations bills.

[ii] The House FY26 Labor HHS appropriations bill states that “Of the amounts made available in this Act for NIH, the amount for research related to the human immunodeficiency virus, as jointly determined by the Director of NIH and the Director of the Office of AIDS Research, shall be made available to the ‘Office of AIDS Research’ account.”


Potential Story Lines from Trump-Era Health Care Cuts

Author: Larry Levitt
Published: Sep 11, 2025

In his latest column for the JAMA Health Forum, KFF’s Larry Levitt talks about how popular shows like “The Pitt” can make changes to the health care system stemming from this year’s federal tax and budget bill tangible for viewers, and offers five suggested story lines that would illustrate how health care is changing under the Trump administration.

VOLUME 30

Changing COVID-19 Booster Policies and Florida’s Decision to End Vaccine Mandates Create Confusion


Summary

This volume explores confusion around COVID-19 booster eligibility as federal recommendations shift and conflicting guidance from physician organizations creates uncertainty for patients. It also looks at Florida’s decision to end school vaccine mandates, with some social media users confusing it with a statewide vaccine ban. Lastly, it highlights research demonstrating that artificial intelligence chatbots can provide generally sound advice for cardiovascular health, but struggle to make specific and personalized recommendations.


Recent Developments

Online Discussion Reflects Confusion About COVID-19 Booster Eligibility

Thanasis / Getty Images

Conversation about COVID-19 vaccines and boosters on social media in late August and early September reflected confusion about eligibility following an FDA decision to only approve updated booster shots for people age 65 and older, or with underlying health conditions. The limited approval represents a shift from previous recommendations that included healthy children and young adults. The change follows a May announcement by the Centers for Disease Control and Prevention (CDC) that COVID-19 vaccines would no longer be recommended for healthy pregnant people and only after a shared clinical decision-making process for healthy children. Online reaction to the FDA decision combined praise for Secretary of Health and Human Services (HHS) Robert F. Kennedy Jr. with the spread of false vaccine safety claims. Kennedy’s post about the announcement on X received 77,000 likes and 15,000 reposts, including endorsements from influential accounts with follower counts ranging from over 100,000 to more than a million. Some reposts praised the decision and repeated claims that COVID-19 vaccines are unsafe for human use, while others shared anecdotal stories of health decline following mRNA vaccination. Others, though, expressed concern about their ability to receive the updated vaccines, which specifically target the currently circulating variants of the virus.

In contrast with official guidance from government agencies, leading physician organizations, including the American Academy of Pediatrics (AAP) and American College of Obstetricians and Gynecologists (ACOG), have issued broader guidelines for COVID-19 boosters, consistent with their past recommendations. These guidelines cite evidence that vaccines prevent severe illness and death in healthy children and pregnant people. Historically, these organizations’ guidelines have generally aligned with federal agencies, but recent conflicting vaccine recommendations may contribute to confusion and varying levels of trust. KFF’s July Tracking Poll on Health Information and Trust found that personal doctors or health care providers remain the most trusted source for information about vaccines, with 83% of adults saying they trust their doctor “a great deal” or “a fair amount” to provide reliable vaccine information. Only 57% say they have the same level of trust in the CDC.

The conflicting guidance and confusion about eligibility comes after the KFF poll found that most adults do not plan to receive the updated COVID-19 vaccine this fall. Most of the public (59%) said they would “probably not” or “definitely not” get the booster, while one-third (33%) of adults said they were concerned that the vaccine would not be available to them. Black and Hispanic adults, who have been disproportionately affected by COVID-19, were among the most concerned about access to this fall’s vaccine. HHS Secretary Kennedy indicated in a post on X that the boosters would remain available for all patients who wish to receive them after consulting with a doctor. Kennedy later reiterated that claim in testimony before a Senate panel, referring to the practice of off-label prescribing, which occurs when a doctor prescribes a drug for a use not approved by the FDA. Prescriptions have not been required for previous formulations of the booster vaccines, and some doctors and pharmacists have expressed hesitancy to prescribe the updated boosters for off-label use. Insurance coverage may also be affected; insurers are generally required to cover vaccines recommended by the ACIP and adopted by the CDC. The advisory committee is expected to issue its updated vaccination guidelines this month.

Some Social Media Users Conflate Florida’s Move to End School Vaccine Mandates with a Vaccine Ban

10’000 Hours / Getty Images

Confusion about vaccine eligibility also appeared in online reaction to a Florida proposal to end school mandates for routine childhood vaccination, with some posts misrepresenting the policy shift as a statewide ban on vaccines. Florida’s Surgeon General announced in early September that the state planned to end all vaccine mandates, including those required for school entry. KFF’s monitoring of social media indicated that there were more posts on X about vaccines on the day of the announcement than at any other point this year thus far. Some posts observed in KFF’s monitoring of social media mistook the Florida policy for a “ban” of vaccines, but government officials framed the decision as removing requirements while keeping vaccines available to families who choose them. Prior to this decision, all 50 states had required children starting school to be vaccinated against transmissible diseases, including measles, mumps, and rubella (MMR).

The proposed policy change comes as childhood vaccination rates are declining and falling below levels that epidemiologists say are needed to prevent disease outbreaks. An August KFF issue brief detailed that nationwide, the MMR vaccination rate has fallen below the federal target of 95% in every year since 2020. Some states, including Florida, had lower rates of coverage, with just 89% of kindergarteners in Florida vaccinated against MMR in the 2024-2025 school year. Despite the move to eliminate mandates,  findings from a KFF-Washington Post survey show that most Florida parents support public school vaccine mandates. 82% of Florida parents, and 81% of parents nationwide, said they believed public schools should require vaccines for measles and polio, with some religious or medical exemptions.

The Florida announcement comes as officials in some other states have indicated plans to make their own vaccine recommendations, expressing concerns about federal vaccine policy decisions by the Trump administration. Some vaccinologists have warned that diverging state and federal guidance could broadly undermine trust in vaccines and public health institutions and leave parents unsure about which guidance to follow.


AI & Emerging Technology

Chatbots Perform Well for Heart Health Advice, But Struggle with Details

KFF / Unsplash

A recent study published in Cureus evaluated how well four leading artificial intelligence (AI) chatbots perform in providing advice for cardiovascular health, finding that most AI models can generally offer sound guidance but fall short in delivering specific, actionable recommendations. Researchers tested ChatGPT, Claude AI, DeepSeek AI, and Google Gemini using 15 standardized questions drawn from diet and exercise guidelines published by organizations like the American Heart Association (AHA) and European Society of Cardiology (ESC). Medical professionals then rated the appropriateness of the chatbots’ responses, finding that all responses to questions about physical activity met established standards. Of the questions about diet, 90% of responses from ChatGPT, Claude, and DeepSeek met established standards, while Gemini performed slightly worse at 80%.

The study revealed limitations despite the generally positive results. While the chatbots’ recommendations were not dangerous, they sometimes went beyond official guidelines in ways that could be helpful for healthcare providers to understand. For example, the models sometimes suggested activities like yoga, tai chi, and water aerobics that were not included in cardiovascular disease association guidelines but may appeal to patients seeking more holistic or natural approaches to heart health. In response to questions about diet, the models struggled with dietary specifics, failing to provide precise quantitative guidelines on carbohydrate and added sugar intake. Gemini, for example, recommended consuming less added sugar, but did not include the specific recommendation from both the AHA and ESC that added sugars should account for less than 10% of total caloric intake.

The research suggests that as patients increasingly turn to AI for health information, healthcare providers may benefit from being aware of the types of advice patients are receiving from these sources. Increased awareness could help clinicians provide more comprehensive medical guidance that acknowledges patients’ interest in alternative approaches while ensuring they receive evidence-based care. While these AI tools can effectively supplement guidance from medical professionals, they can not replace personalized, quantitative recommendations that may be offered by physicians or other licensed providers like nutritionists or dieticians. Users should verify AI-generated health advice with their healthcare providers before making significant lifestyle changes.

About The Health Information and Trust Initiative: the Health Information and Trust Initiative is a KFF program aimed at tracking health misinformation in the U.S., analyzing its impact on the American people, and mobilizing media to address the problem. Our goal is to be of service to everyone working on health misinformation, strengthen efforts to counter misinformation, and build trust. 


View all KFF Monitors

The Monitor is a report from KFF’s Health Information and Trust initiative that focuses on recent developments in health information. It’s free and published twice a month.

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Support for the Health Information and Trust initiative is provided by the Robert Wood Johnson Foundation (RWJF). The views expressed do not necessarily reflect the views of RWJF and KFF maintains full editorial control over all of its policy analysis, polling, and journalism activities. The data shared in the Monitor is sourced through media monitoring research conducted by KFF.

Overview of President Trump’s Executive Actions on Global Health

Published: Sep 10, 2025

Note: Originally published on Jan. 28, 2025, this resource is updated as needed, most recently on September 10, 2025, to reflect additional developments. 

Starting on the first day of his second term, President Trump began to issue numerous executive actions, several of which directly address or affect U.S. global health efforts.* This guide provides an overview of these actions, in the order in which they were issued. The “date issued” is date the action was first taken; subsequent actions are listed under “What Happens/Implications.” See an accompanying timeline of events specific to the foreign aid review and USAID dissolution.

President Trump’s Executive Actions on Global Health

Initial Rescissions Of Harmful Executive Orders And Actions, January 20, 2025
PURPOSE: Initial rescissions of Executive Orders and Actions issued by President Biden.

Among these orders are several that addressed the COVID-19 pandemic and global health security, such as Executive Order 13987 (Organizing and Mobilizing the United States Government To Provide a Unified and Effective Response To Combat COVID-19 and To Provide United States Leadership on Global Health and Security),  which among other things established the National Security Council Directorate on Global Health Security and Biodefense and a Senior Director position to oversee it.

What Happens Next/Implications: Given that most of the provisions in the COVID-19 and Global Health Security actions issued by President Biden are no longer current or relevant, the rescissions of these actions are likely to have minimal effect on government policies. One exception may be the elimination of the Directorate of Global Health Security and Biodefense and its Senior Director at the National Security Council, which were responsible for interagency coordination on global health security matters during the Biden Administration. The elimination of this office echoes a similar move made during the first Trump Administration to eliminate an NSC Directorate for Global Health Security, and raises questions about who and which offices at NSC (and across the government) will fill this coordination role in the new Administration. More rescissions of other Biden administration Executive Actions may be issued at a later date.
Withdrawing The United States From The World Health Organization, January 20, 2025
PURPOSE: To withdraw from the World Health Organization (WHO).

“The United States noticed its withdrawal from the World Health Organization (WHO) in 2020 due to the organization’s mishandling of the COVID-19 pandemic that arose out of Wuhan, China, and other global health crises, its failure to adopt urgently needed reforms, and its inability to demonstrate independence from the inappropriate political influence of WHO member states.  In addition, the WHO continues to demand unfairly onerous payments from the United States, far out of proportion with other countries’ assessed payments.  China, with a population of 1.4 billion, has 300 percent of the population of the United States, yet contributes nearly 90 percent less to the WHO.”

ACTIONS: The United States intends to withdraw from the WHO. 
The Presidential Letter to the Secretary-General of the United Nations signed on January 20, 2021, that retracted the United States’ July 6, 2020, notification of withdrawal is revoked.
Executive Order 13987 (Organizing and Mobilizing the United States Government to Provide a Unified and Effective Response to Combat COVID–19 and To Provide United States Leadership on Global Health and Security), which, among other things, called for “engaging with and strengthening the World Health Organization” is revoked.
Assistant to the President for National Security Affairs shall establish directorates and coordinating mechanisms within the National Security Council apparatus as necessary and appropriate to safeguard public health and fortify biosecurity.
The Secretary of State and Director of the Office of Management and Budget shall take actions to pause future transfer of any U.S. funds, support, or resources to WHO; recall and reassign U.S. government personnel or contractors working in any capacity with WHO; and identify credible and transparent U.S. and international partners to assume necessary activities previously undertaken by WHO.
The Director of the White House Office of Pandemic Preparedness and Response Policy shall review, rescind, and replace the 2024 U.S. Global Health Security Strategy.
The Secretary of State shall immediately inform the Secretary-General of the United Nations, any other applicable depositary, and the leadership of the WHO of the withdrawal.
While the withdrawal is in progress, Secretary of State will cease negotiations on the WHO Pandemic Agreement and the amendments to the International Health Regulations, and states that “actions taken to effectuate such agreement and amendments will have no binding force on the United States.”
What Happens Next/Implications: President Trump initiated a process to withdraw from the WHO during his first term in office, a process that takes a year to finalize, and halted funding. This time period was not met when President Biden took office and he reversed this decision and restored funding. Now, after issuance of a formal letter of withdrawal United Nations and WHO, the process will be initiated once again. Such a letter has been issued, indicating that membership will end as of January 22, 2026.

Per the Executive Order, U.S. government representatives may not work with WHO. While U.S. representatives attended the Executive Board meeting in February (the U.S. previously held a seat on the Executive Board), no representatives attended the World Health Assembly in May, where world leaders adopted the Pandemic Agreement. On May 30, the White House released details on the President’s Budget Request for FY 2026, requesting eliminated funding for WHO. Further, on June 3, the administration asked Congress to rescind funds previously appropriated for fiscal years 2024 and 2025, including contributions to WHO. However, for both the FY 2026 appropriations and FY2024-25 rescissions, Congress will determine the final funding levels.

As the largest donor to WHO providing approximately 16%-18% of the organization’s revenue, the absence of U.S. funding will have an impact WHO’s operations, as will the loss of U.S. technical expertise. See: KFF Fact Sheet and Quick Take
Reevaluating And Realigning United States Foreign Aid, January 20, 2025
PURPOSE: To pause funding and review all U.S. foreign assistance to assess alignment with American values.

The U.S. “foreign aid industry and bureaucracy are not aligned with American interests and in many cases antithetical to American values. They serve to destabilize world peace by promoting ideas in foreign countries that are directly inverse to harmonious and stable relations internal to and among countries.”

“It is the policy of United States that no further United States foreign assistance shall be disbursed in a manner that is not fully aligned with the foreign policy of the President of the United States.”

Calls for:

90-day pause in U.S. foreign development assistance (new obligations or disbursements) to assess programmatic efficiencies and consistency with U.S. foreign policy.
Review of U.S. foreign assistance programs by the responsible department and agency heads under guidelines provided by the Secretary of State, in consultation with the Director of OMB.
Responsible department and agency heads, in consultation with the Director of OMB, will make determinations within 90 days of this order on whether to continue, modify, or cease each foreign assistance program based upon the review recommendations, with the concurrence of the Secretary of State.
New obligations and disbursements may resume for a program prior to the end of the 90-day period if a review is conducted, and the Secretary of State or his designeein consultation with the Director of OMB, decide to continue the program in the same or modified form.  Additionally, any other new foreign assistance programs and obligations must be approved by the Secretary of State or his designee, in consultation with the Director of OMB.
The Secretary of State may waive the pause for specific programs.
What Happens Next/Implications: Almost all global health programs are funded through foreign aid appropriations and are therefore subject to this order. The order temporarily freezes any new U.S. government spending (obligations or disbursements) through these programs, which could interrupt implementation of programs for which funds have not yet been obligated. It also calls for a 90-day review of all foreign aid programs. Key developments are as follows:
On January 24, 2025, A Notice on Implementation of the Executive Order was issued by USAID which, among other things, calls for stop-work orders to be issued for all existing foreign assistance awards (not just new obligations and disbursements). It notes that waivers have been granted for: foreign military financing for Israel and Egypt and emergency food assistance (and related expenses) and, on a temporary basis, salaries and related administrative expenses, including travel, for U.S. direct hire employees, personal services contractors, and locally employed staff. The stop-work order on existing awards halted U.S. global health (and other foreign assistance) programs that were already underway, placing key programs at risk of not being able to provide critical services, and affecting access for individuals on the ground, unless a waiver was received.
On January 28, the Secretary of State  issued a blanket waiver for life-saving humanitarian assistance programs, which also lays out a process for requesting additional waivers (more information is here). This guidance also states that the waiver does not apply to “activities that involve abortions, family planning, conferences, administrative costs [unless associated with waived activities], gender or DEI ideology programs, transgender surgeries, or other non-life saving assistance.”
On February 1, PEPFAR, the global HIV/AIDS program, was granted a limited waiver enabling it to resume or continue “urgent life-saving HIV treatment  services”, defined as a set of care and treatment services and prevention of mother-to-child transmission services.
On February 4, some additional services for other global health programs  – tuberculosis; malaria; acute risks of maternal and child mortality, including severe acute malnutrition; and other life-threatening diseases and health conditions – deemed to be “lifesaving” were also granted a limited waiver to allow them to resume or continue.
On February 6, a lawsuit was filed by Democracy Forward and Public Citizen Litigation Group, on behalf of the American Foreign Service Association and American Federation of Government Employees, challenging the foreign aid funding freeze, the plan to put most staff on leave, and the fact that staff had already been placed on leave; on February 7, they filed a temporary restraining order (TRO). That same day, a temporary restraining order was issued by the U.S. District Court in the District of Columbia preventing the government from placing additional staff on leave or evacuating staff back to the U.S., and requiring reinstatement of all staff already placed on leave, until February 14. The court did not grant a TRO on the funding freeze, on the grounds that the plaintiffs in this case did not demonstrate that the freeze caused them irreparable harm. On February 13, the court extended the TRO through February 21 (further actions are described below, as this case was combined with another for purposes of the court’s consideration).
On February 10, a lawsuit was filed in the U.S. District Court for the District of Columbia on behalf of two U.S. organizations seeking emergency relief from the freeze on funding for foreign assistance (AVAC v. United States Department of State).
On February 11, a lawsuit was filed in the U.S. District Court for the District of Columbia on behalf of several U.S. organizations challenging the executive order and subsequent actions freezing foreign aid and dissolving USAID, and asking the court to temporarily restrain and preliminarily and permanently enjoin Defendants from implementing these actions (Global Health Council v. Trump).
On February 13, the court, in a ruling pertaining to the February 10 and February 11 lawsuits brought by numerous U.S. organizations, issued a TRO preventing the Trump administration from “suspending, pausing, or otherwise preventing the obligation or disbursement of appropriated foreign-assistance funds in connection with any contracts, grants, cooperative agreements, loans, or other federal foreign assistance award that was in existence as of January 19, 2025; or issuing, implementing, enforcing”, or “otherwise giving effect to terminations, suspensions, or stop-work orders in connection with any contracts, grants, cooperative agreements, loans, or other federal foreign assistance award that was in existence as of January 19, 2025.”
On February 14, the parties filed a joint status report proposing an expedited preliminary injunction briefing schedule.
On February 18, the government filed a required status report stating that, despite the TRO, it had the authority to cancel contracts and suspend grant awards.
This was followed by a February 19 request by the February 10 plaintiffs (AVAC v. Department of State) for an emergency motion to enforce the TRO and to hold the defendants in civil contempt.
The defendants filed a required response on February 20, stating that they have not violated the TRO and should not be held in contempt, which was again opposed by the plaintiffs. Also on February 20, the February 11 plaintiffs (Global Health Council v. Trump) filed a response to the defendant’s status report with a motion to enforce the TRO.  The court reaffirmed the TRO on February 20 (but did not hold the defendants in contempt), stating it was prepared to hold a hearing on the preliminary injunction motions in both cases by March 4, 2025 and that the TRO would be in place through March 10, 2025, or the date the Court resolves the preliminary injunction motions, whichever is sooner.
The plaintiffs filed an emergency order to enforce the TRO on February 24, due to continued lack of payment, and the court issued a motion to enforce on February 25. The government appealed, (asking for a stay pending appeal) but this was denied by the court. The government then appealed to the Supreme Court and was granted a stay until February 28 while the case was considered.
On March 5, the Supreme Court denied the government’s request to vacate the federal district court’s TRO, sending the order back to the district court to clarify the government’s obligations for ensuring compliance with the TRO.
On March 6, the federal district court judge ordered the government to release all payments that were due to plaintiffs as of February 13, by Monday, March 10 at 6pm, and on March 10, the federal district court judge preliminarily enjoined the government from taking certain actions related to the foreign aid freeze.
On March 10, Secretary Rubio announced that a six-week review had been completed and that 83% of programs at USAID (5,200 contracts) had been cancelled. That same day, the court  preliminarily enjoined the government from enforcing actions taken to implement the foreign aid freeze (requiring it to reverse any terminations, suspensions, and stop-work orders and to pay for any work completed by February 13). The court stated that the government was “enjoined from unlawfully impounding congressionally appropriated foreign aid funds and shall make available for obligation the full amount of funds that Congress appropriated for foreign assistance programs in the Further Consolidated Appropriations Act of 2024.”
On April 1, the government filed an appeal with the U.S. Court of Appeals for the District of Columbia challenging the preliminary injunction issued on March 10.
On April 17, the administration extended the foreign aid review for another 30 days from the original deadline of April 20, 2025.
On May 2 and May 30, the White House released information on its budget request for FY 2026, proposing significant decreases, and in some cases eliminations, of funding for global health activities. However, Congress will determine the final funding levels.
On June 3, the administration asked Congress to rescind previously appropriated funds for fiscal years 2024 and 2025, including $8.3 billion in foreign assistance, of which at least $1.2 billion was designated for global health. However, Congress will need to approve any potential rescissions.
• On August 13, the U.S. District Court of Appeals for the District of Columbia Circuit partially vacated the March 10 preliminary injunction in the cases GHC v. Trump and AVAC v. State Department which required the government to make congressionally appropriated foreign assistance funds available for obligation. The appeals court ruled that the plaintiffs did not have the authority to challenge the President’s impoundment of funds. Instead, the court ruled that challenges of impoundment should be brought forward by the Comptroller General.
• On August 28, the U.S. District Court of Appeals for the District of Columbia Circuit amended its opinion, clarifying that while plaintiffs did not have the authority to challenge impoundment of foreign assistance funds through the Impoundment Control Act, they could seek relief through the Administrative Procedures Act. Following this amended opinion, plaintiffs in GHC v. Trump and AVAC v. State Department cases motioned for a preliminary injunction in the U.S. district court on September 1. On September 3, the U.S. district court granted the preliminary injunction, ordering defendants to obligate expiring foreign assistance funds before the end of the fiscal year on September 30. On September 4, defendants appealed this preliminary injunction and requested a stay on the preliminary injunction pending the resolution of the appeals case, from both the district court and appeals court. These requests were both denied on September 5. On September 8, defendants requested a stay of the preliminary injunction from the U.S Supreme Court. On September 9, the Chief Justice of the Supreme Court granted a partial stay of the preliminary injunction.

The 90-day review of foreign assistance was initially supposed to go through April 19, 2025, however, has been granted a 30-day extension.
America First Policy Directive To The Secretary Of State, January 20, 2025
PURPOSE: To put core American interests first in foreign policy.

The foreign policy of the United States “shall champion core American interests and always put America and American citizens first.”

“As soon as practicable, the Secretary of State shall issue guidance bringing the Department of State’s policies, programs, personnel, and operations in line with an America First foreign policy, which puts America and its interests first.”
What Happens Next/Implications: The State Department is responsible for the supervision and overall strategic direction of foreign assistance programs administered by the State Department and USAID, which includes the vast majority of global health assistance. It also directly oversees PEPFAR, the global HIV/AIDS program, and many aspects of global health diplomacy for the U.S. Priorities and approaches for these and other global health programs are likely to be shaped by how the White House and State Department leadership define “America First” foreign policy and American interests, and how that definition is implemented in practice.

In the President’s Budget Request for FY 2026, the request proposes eliminated funding for several global health activities, including family planning and reproductive health (FPRH), neglected tropical diseases (NTDs), and nutrition, stating these are “programs that do not make Americans safer”. However, Congress will determine final funding levels and whether to include these eliminations in its appropriations bills.

Defending Women From Gender Ideology Extremism And Restoring Biological Truth To The Federal Government, January 20, 2025
PURPOSE: To define sex as an immutable binary biological classification and remove recognition of the concept of gender identity.

The order states that “It is the policy of the United States to recognize two sexes, male and female” and directs the Executive Branch to “enforce all sex-protective laws to promote this reality”. Elements of the order that may affect global health programs are as follows:

Defines sex as “an individual’s immutable biological classification as either male or female”.  States that “sex” is not a synonym for and does not include the concept of “gender identity” and that gender identity “does not provide a meaningful basis for identification and cannot be recognized as a replacement for sex.”
Directs the Secretary of Health and Human Services to provide the U.S. Government, external partners, and the public clear guidance expanding on the sex-based definitions set forth in the order within 30 days.
Directs each agency and all Federal employees to “enforce laws governing sex-based rights, protections, opportunities, and accommodations to protect men and women as biologically distinct sexes, including when interpreting or applying statutes, regulations, or guidance and in all other official agency business, documents, and communications.
Directs each agency and all Federal employees, when administering or enforcing sex-based distinctions, to use the term “sex” and not “gender” in all applicable Federal policies and documents.
Directs agencies to remove all statements, policies, regulations, forms, communications, or other internal and external messages “that promote or otherwise inculcate gender ideology”, and shall cease issuing such statements, policies, regulations, forms, communications or other messages. Directs agencies to take all necessary steps, as permitted by law, to end the Federal funding of gender ideology.
Requires that Federal funds shall not be used to promote gender ideology and directs agencies to ensure grant funds do not promote gender ideology.
Rescinds multiple executive orders issued by President Biden, including: “Preventing and Combating Discrimination on the Basis of Gender Identity or Sexual Orientation” (13988) and “Advancing Equality for Lesbian, Gay, Bisexual, Transgender, Queer, and Intersex Individuals” (14075).
What Happens Next/Implications: This order is broad, directed to all federal agencies and programs. Because PEPFAR, and some other U.S. global health programs, serve people who are members of the LGBTQ community, guidance and implementation could affect the ability of these programs to reach individuals and organizations and provide them with services. In addition, the order will likely result in the removal of existing protections based on sexual orientation and gender identity, which had been provided in agency guidance for global health and development programs. Implementation guidance has been issued and all federal agencies must comply.
Memorandum For The Secretary Of State, The Secretary Of Defense, The Secretary Of Health And Human Services, The Administrator Of The United States Agency For International Development, January 24, 2025
PURPOSE: To reinstate Mexico City Policy and direct review of programs per the Kemp-Kasten Amendment.
• Revokes President Biden’s Presidential Memorandum of January 28, 2021 for the Secretary of State, the Secretary of Defense, the Secretary of Health and Human Services, and the Administrator of the United States Agency for International Development (Protecting Women’s Health at Home and Abroad)
Reinstates President Trump’s Presidential Memorandum of January 23, 2017 for the Secretary of State, the Secretary of Health and Human Services, and the Administrator of the United States Agency for International Development (The Mexico City Policy).
Directs the Secretary of State, in coordination with the Secretary of Health and Human Services, to the extent allowable by law, to implement a plan to extend the requirements of the reinstated Memorandum to global health assistance furnished by all departments or agencies.
Directs the Secretary of State to take all necessary actions, to the extent permitted by law, to ensure that U.S. taxpayer dollars do not fund organizations or programs that support or participate in the management of a program of coercive abortion or involuntary sterilization.
What Happens Next/Implications: The Mexico City Policy is a U.S. government policy that – when in effect – has required foreign NGOs to certify that they will not “perform or actively promote abortion as a method of family planning” using funds from any source (including non-U.S. funds) as a condition of receiving U.S. global family planning assistance and, when in place under the Trump administration, most other U.S. global health assistance. First announced in 1984 by the Reagan administration, the policy has been rescinded and reinstated by subsequent administrations along party lines since; it was widely expected that the President Trump would reinstate it in his second term. The new memorandum calls for the implementation of a plan to extend the requirements to global health assistance furnished by all departments or agencies; until the plan is ready, the scope of the new memorandum is unknown.

The new memorandum also directs the Secretary of State to review programs under the Kemp-Kasten amendment, a provision of U.S. law that states that no U.S. funds may be made available to “any organization or program which, as determined by the [p]resident of the United States, supports or participates in the management of a program of coercive abortion or involuntary sterilization.” It has been used in the past to prevent funding from going to UNFPA.

See: KFF Mexico City Policy explainer and related resources and Kemp-Kasten explainer.
Renewed Membership in the Geneva Consensus Declaration on Promoting Women’s Health and Strengthening the Family, January 24, 2025
PURPOSE: To rejoin the Geneva Consensus Declaration.

The United States informed signatories of the Geneva Consensus Declaration of its intent to rejoin immediately. Established in 2020, the declaration, led by the United States, has the following objectives: “to secure meaningful health and development gains for women; to protect life at all stages; to defend the family as the fundamental unit of society; and to work together across the UN system to realize these values.”

What Happens Next/Implications: The Geneva Consensus Declaration, initially crafted and signed by the U.S. – along with 31 other countries at the time – was meant to enshrine certain values and principles related to women’s health and family, including a rejection of the “international right to abortion.”  The Biden administration withdrew from the Consensus in 2021.
Review of and Changes to USAID, January 27, 2025
Reorganization of the Department of State, April 22, 2025
PURPOSE: To review and potentially reorganize USAID “to maximize efficiency and align operations with the national interest,” which may include the suspension or elimination of programs, projects, or activities; closing or suspending missions or posts; closing, reorganizing, downsizing, or renaming establishments, organizations, bureaus, centers, or offices; reducing the size of the workforce at such entities; and contracting out or privatizing functions or activities performed by federal employees.What Happens Next/Implications: Related to but separate from the Executive Order on reevaluating and realigning foreign aid and on the America first policy directive to the Secretary of State, the administration has made changes to and begun a review of USAID, the U.S. government’s international development agency which oversees and/or implements most U.S. global health programs (see, The U.S. Government and Global Health). Key developments are as follows:
On January 27, senior USAID career staff were placed on leave and hundreds of other staff were let go.
On February 2, the USAID website was taken down.
On February 3, the USAID building in DC was closed, which has prevented other staff from accessing it.
The President appointed Secretary of State Rubio as Acting USAID Administrator on February 3. Secretary Rubio has said that the agency has “conflicting, overlapping, and duplicative functions that it shares with the Department of State” and that its systems and processes are not “well synthesized, integrated, or coordinated, and often result in discord in the foreign policy and foreign relations of the United States.” President Trump and other administration officials have called for dissolving the agency altogether. Formal notification of the intent to review the agency was sent by Secretary Rubio to Congress on February 3.
On February 4, a notice was posted on the USAID website stating that on February 7, all USAID direct hire personnel would be placed on administrative leave globally, with the exception of “designated personnel responsible for mission­ critical functions, core leadership and specially designated programs.” The notice also said that staff posted outside the United States would need to return to the U.S. within 30 days.
On February 6, a lawsuit was filed by Democracy Forward and Public Citizen Litigation Group, on behalf of the American Foreign Service Association and American Federation of Government Employees, challenging the foreign aid funding freeze, the plan to put most staff on leave, and the fact that staff had already been placed on leave; on February 7, they filed for a temporary restraining order (TRO). That same day, a temporary restraining order was issued by the U.S. District Court in the District of Columbia preventing the government from placing additional staff on leave or evacuating staff back to the U.S., and requiring reinstatement of all staff already placed on leave, until February 14. The court did not grant a TRO on the funding freeze, on the grounds that the plaintiffs in this case did not demonstrate that the freeze caused them irreparable harm. On February 13, the court extended the TRO through February 21, at which time, the court determined that further preliminary injunctive relief was not warranted and the TRO was ended, allowing the government to dismiss USAID staff.
On February 11, a lawsuit was filed in the U.S. District Court for the District of Columbia on behalf of several U.S. organizations challenging the executive order pausing foreign aid, and subsequent actions freezing foreign aid and dissolving USAID, and asking the court to temporarily restrain and preliminarily and permanently enjoin Defendants from implementing these actions. In a February 13 ruling, a federal court issued a TRO preventing the Trump administration from freezing foreign aid assistance but stated that the proposed injunctions related to USAID were overbroad (in a separate case, the district court ended the TRO on dismissing USAID staff – see above).
On February 13, a lawsuit was filed in the U.S. District Court for the District of Maryland by 26 former and current employees of USAID, suing Elon Musk and DOGE for taking actions to control and dissolve the agency. On February 18, the plaintiffs filed a motion for preliminary injunction. The defendants responded on February 24 and the plaintiffs replied on February 26. On March 18, the court granted a preliminary injunction, requiring the defendants to reverse many of the actions taken to dissolve USAID, and on March 21, the defendants filed an appeal on the preliminary injunction. On March 25, the U.S. 4th Circuit Court of Appeals granted the defendants’ motion for a temporary stay on the preliminary injunction, allowing DOGE to resume its efforts to dissolve USAID, until March 27. The following day on March 28, the court granted defendants’ motion for a stay, clearing the path for DOGE to continue its work dissolving USAID.
On February 18, a lawsuit was filed in the U.S. District Court for the District of Columbia on behalf of the Personal Services Contractor Association (representing USAID personal service contractors) challenging the suspension of foreign assistance and the actions related to USAID, including “steps to dismantle USAID, cripple its operations, or transfer its functions to the State Department without Congressional authorization”. On February 19, the plaintiffs filed a motion for a temporary restraining order. On March 6, the court denied the TRO request.
On March 28, Secretary Rubio announced that the Department of State and USAID have notified Congress on their intent to “undertake a reorganization that would involve realigning certain USAID functions to the Department by July 1, 2025, and discontinuing the remaining USAID functions that do not align with Administration priorities.” Additionally, nearly all the remaining USAID staff received notice that they would be subject to a final reduction-in-force.
On April 22, Secretary Rubio announced the Department of State’s reorganization plan and new organization chart. The plan states that it would consolidate functions and remove non-statutory programs that are “misaligned with America’s core national interests.”
On April 28, a lawsuit was filed by a group of labor unions, non-profits, and local governments challenging the administration’s moves to drastically reshape several federal agencies without congressional approval (American Federation of Government Employees v. Trump). The district court issued a TRO on May 9 and preliminary injunction on May 22 ordering the administration to pause large-scale reductions in force, program eliminations, and other actions related to federal agency restructuring. An emergency motion by the government for a stay pending appeal of the district court’s preliminary injunction was denied on May 30.
On May 2 and May 30, the White House released information on its budget request for FY 2026, noting the reorganization of USAID into the Department of State.
On May 29, the Department of State notified Congress of its reorganization plans, including absorbing USAID’s continued functions.
On June 13, the district court in American Federation of Government Employees v. Trump ruled that the actions of the Department of State, including the reorganization announcement and notification to Congress, were in violation of the preliminary injunction.
On July 8, the U.S. Supreme Court granted the government’s request for a stay of the preliminary injunction pending resolution of the appeals case in American Federation of Government Employees v. Trump, allowing the government to move forward with large-scale reductions to federal agency operations and workforces, including at the State Department.

While initially created through Executive Order in 1961 as part of the State Department, the Foreign Affairs Reform and Restructuring Act of 1998 established it as an independent agency within the executive branch. As such, the Executive branch does not have authority to dissolve it without Congress, and Congress also requires notification first as well as consultation on any proposed changes.
Withdrawing the United States From and Ending Funding to Certain United Nations Organizations and Reviewing United States Support to All International Organizations, February 4, 2025
PURPOSE: To review United States participation in all international intergovernmental organizations, conventions, and treaties and to withdraw from and end funding to certain United Nations (U.N.) organizations.

The U.S. “helped found” the U.N. “after World War II to prevent future global conflicts and promote international peace and security.  But some of [its] agencies and bodies have drifted from this mission and instead act contrary to the interests of the United States while attacking our allies and propagating anti-Semitism.”
States that the U.S. “will reevaluate our commitment to these institutions,” including three organizations that “deserve renewed scrutiny”:
the U.N. Human Rights Council (UNHRC; the U.S. will not participate in and withhold its contribution to the budget of the body),
the U.N. Educational, Scientific, and Cultural Organization (UNESCO; the U.S. will conduct a review of its membership in the body within 90 days), and
the U.N. Relief and Works Agency for Palestine Refugees in the Near East (UNRWA; reiterates that the U.S. will not contribute to the body).

    Requires that within 180 days:
  • • the Secretary of State, with the U.S. Ambassador to the U.N., conduct a review of all international intergovernmental organizations of which the U.S. is a member and provides any type of funding or other support, and all conventions and treaties to which the United States is a party, to determine which organizations, conventions, and treaties are contrary to the interests of the United States and whether such organizations, conventions, or treaties can be reformed; and
the Secretary of State to report the findings of the review to the President, through the National Security Advisor, and provide recommendations as to whether the U.S. should withdraw from any such organizations, conventions, or treaties.
What Happens Next/Implications: With a long history of multilateral global health engagement, the U.S. is often the largest or one of the largest donors to multilateral health efforts (i.e., multi-country, pooled support often directed through an international organization). It provided $2.4 billion in assessed or core contributions in FY 2024 – 19% of overall U.S. global health funding – as well as more funding in voluntary or non-core contributions.

The U.S. is also a signatory or party to numerous global health-related international conventions, treaties, and agreements; these include those that played a role in the global COVID-19 response (such as the International Health Regulations). It often has participated in negotiations for new international instruments, although the Trump administration indicated in a Jan. 20, 2025, Executive Order, listed above, that the U.S. would no longer engage in the Pandemic Agreement (sometimes called the “Pandemic Treaty”) negotiations.

This Executive Order will have immediate impacts via the ordered actions related to the three U.N. organizations specified, much as the impacts of the Jan. 20, 2025, Executive Order on the World Health Organization (WHO, which initiated U.S. withdrawal from membership and halted U.S. funding) are already being seen. Beyond these, additional impacts of this Executive Order will be determined by the findings and recommendations of the international organizations and conventions review, particularly if U.S. support for or membership in some international organizations is recommended to be reduced or eliminated and if it recommends the U.S. withdraw from any international agreements.

Congressional notification and oversight of any proposed changes will also be important to watch, including debates about whether advice or consent or congressional notification periods are or may be required prior to withdrawing the U.S. from international instruments such as treaties.

The administration has already signaled plans to discontinue support for several international organizations in its budget request for FY 2026 by proposing eliminated funding for Gavi, the Pan American Health Organization (PAHO), the United Nations Children’s Fund (UNICEF), the United Nations Population Fund (UNFPA), and the World Health Organization (WHO). However, Congress will determine final funding levels and whether to include these eliminations in its appropriations bills.

The 180 day review of all international intergovernmental organizations goes through August 3, 2025.
Memorandum For The Heads Of Executive Departments And Agencies, February 6, 2025
PURPOSE: The memorandum seeks to “stop funding Nongovernmental Organizations that undermine the national interest and administration priorities”.

The memorandum:

States: it is Administration policy “to stop funding NGOs [Nongovernmental Organizations] that undermine the national interest.”
Directs heads of executive departments and agencies to review all funding that agencies provide to NGOs and “to align future funding decisions with the interests of the United States and with the goals and priorities of my Administration, as expressed in executive action; as otherwise determined in the judgment of the heads of agencies; and on the basis of applicable authorizing statues, regulations, and terms.”
What Happens Next/Implications: This memo aligns with other Executive actions that target federal funding for global health and foreign assistance programs. Implementation of this memo could result in the Administration halting funding to global health NGOs they determine “do not align with administration priorities.” No criteria for how this determination will be made has been provided.

The majority of U.S. global health assistance is channeled through NGOs. In FY22, for example, 62% of U.S. global health funding was provided to NGOs as prime partners (45% to U.S.-based NGOs and 17% to foreign-based NGOs) and others are likely sub-recipients of U.S. assistance.* As such, this Order could have a significant impact on NGOs if it is determined that they do not align with administration policies.

*Source: KFF analysis of data from www.foreignassistance.gov.
Addressing Egregious Actions of The Republic of South Africa, February 7, 2025
PURPOSE: To stop U.S. support for South Africa due to its “commission of rights violations in its country or its ‘undermining United States foreign policy, which poses national security threats to our Nation, our allies, our African partners, and our interests.”

“It is the policy of the United States that, as long as South Africa continues these unjust and immoral practices that harm our Nation:
(a)  the United States shall not provide aid or assistance to South Africa; and
(b)  the United States shall promote the resettlement of Afrikaner refugees escaping government-sponsored race-based discrimination, including racially discriminatory property confiscation.”

ACTIONS:

All executive departments and agencies, including USAID, shall, to the maximum extent allowed by law, halt foreign aid or assistance delivered or provided to South Africa, and shall promptly exercise all available authorities and discretion to halt such aid or assistance.
The head of each agency may permit the provision of any such foreign aid or assistance that, in the discretion of the relevant agency head, is necessary or appropriate.
The Secretary of State and the Secretary of Homeland Security shall take appropriate steps, consistent with law, to prioritize humanitarian relief, including admission and resettlement through the United States Refugee Admissions Program, for Afrikaners in South Africa. A plan shall be submitted to the President through the Assistant to the President and Homeland Security Advisor.
What Happens Next/Implications: South Africa receives a significant amount of global health assistance, particularly for HIV/AIDS, from the United States government. The executive order allows the heads of U.S. agencies to permit the provision of foreign aid or assistance under this order at their discretion. On February 10, the U.S. Embassy and Consulates in South Africa announced that PEPFAR would not be impacted by this Executive Order and could continue under the limited waiver already granted to the foreign aid funding freeze. No other exceptions have yet been announced.

The Government of South Africa has issued a statement in response to the Executive Order that, among other things, expresses concern “by what seems to be a campaign of misinformation and propaganda aimed at misrepresenting our great nation.”

Notes and Sources:

*There are several other Executive Actions issued by the President that instruct all government agencies on a variety of topics and as such broadly affect global health program operations but are not specific to global health. These include, for example, Executive Actions withdrawing from the Paris Agreement under the United Nations Framework Convention on Climate Change and ending DEI programs. These are not included in this resource.

Sources: White House, https://www.whitehouse.gov/presidential-actions/; State Department, www.state.gov.