A year ago, the federal Indian Health Service posted dozens of flyers on Facebook promoting flu and COVID-19 vaccine clinics across the Navajo Nation, where the pandemic had inflicted a staggering toll just a few years earlier.

The notices, featuring photos of smiling families and elders in traditional clothing, tied immunization to tribal values like community responsibility and made a clear case for getting the shots. “Vaccines are effective at preventing serious illness or hospitalization,” one of them said.

But this year, as Health and Human Services Secretary Robert F. Kennedy Jr., a vaccine critic, has put his stamp on federal immunization policy, IHS’ public messaging on vaccines has taken a stark turn.

In internal emails obtained by ProPublica, IHS officials have flagged terms such as “immunizations” and “vaccines” for additional scrutiny, deeming them risky “buzzwords” that require approval from agency public information officers to be used in social media posts, pamphlets and presentations for patients.

Through mid-October, IHS had published far fewer posts on Facebook promoting vaccine clinics this year than last, ProPublica found. And in those posts as well as other notices, it replaced language touting immunization’s benefits with wording that frames both routine childhood vaccinations and annual flu and COVID-19 shots as a personal choice, advising patients to consult health care providers about their “options regarding vaccines.”

Current and former IHS clinicians told ProPublica the changes threaten vaccine uptake in Navajo communities and have left medical practitioners who serve this population feeling censored.

“It seems to me that they’re trying to put up barriers,” said Harry Brown, a physician and epidemiologist who left IHS in 2016 and now works for a tribally operated health facility in North Carolina. In a 26-year career with IHS, he said, he had never encountered an effort to stifle public health campaigns or restrict what medical providers said publicly about vaccines.

Aside from Brown, the health care providers who spoke with ProPublica didn’t want their names used, concerned it could endanger their jobs. One physician said the new IHS restrictions on vaccine-related speech factored into her decision to leave the agency this year.

“I can’t keep people safe,” she said in an interview just before she quit. “I don’t have any of the words anymore to say anything I need to say.”

IHS’ shift in vaccine messaging has not been previously reported but aligns with widely publicized changes within the Department of Health and Human Services under Kennedy’s leadership. In the past 10 months, as measles cases have hit their highest levels in decades, Kennedy has been tepid in endorsing the vaccine to prevent the disease while taking several steps critics predict will undermine public confidence in immunization.

He’s launched a federal probe into scientifically debunked links between immunizations and autism and canceled nearly $500 million in contracts and research grants for mRNA vaccines. This technology was central to the speedy development of the COVID-19 vaccine.

In June, he removed all 17 members of the Advisory Committee on Immunization Practices, which advises the Centers for Disease Control and Prevention on vaccine policy, replacing them with his own appointments, including several vaccine skeptics. Kennedy has also endorsed the founders of Idaho’s medical freedom movement, who helped persuade the state to ban vaccine mandates this year.

At IHS, the only branch of HHS that operates its own network of hospitals and clinics, the altered federal landscape on vaccine policy has had a more direct effect on patient care, clinicians said.

In a statement, an HHS spokesperson said the redrafting of IHS’ public messaging materials was designed to encourage “shared decision-making” between patients and their health care providers.

“The Indian Health Service continues to provide accurate, evidence-based information on vaccines and infectious-disease prevention,” the statement said. “Our focus remains ensuring Tribal communities have clear, trusted guidance and access to the care they choose.”

The statement didn’t address questions about what prompted the revamped messaging or concerns raised by doctors about its potential effect.

In a separate statement, Matthew Clark, the IHS’ deputy chief medical officer, insisted the agency’s approach to immunizations has remained consistent, even if its messaging about them has changed.

“We continue to advocate that every patient at every encounter be offered every FDA-approved and ACIP-recommended vaccine, when appropriate,” Clark’s statement said.

It’s not clear yet what effect the changes are having. Data hasn’t been released showing this season’s flu and COVID-19 vaccination rates for the Navajo Nation. Through September, the uptake rate for the measles, mumps and rubella vaccine, known as MMR, for 2-year-olds has held steady at around 95%, the level of herd immunity needed to prevent outbreaks, IHS data shows.

Still, IHS clinicians said, the agency’s lack of public messaging about vaccines was especially notable during the winter and spring, when a measles outbreak emerged in Texas and then neared the reservation’s borders in New Mexico.

The outbreak had spurred alarm. Tribal health facilities, which operate independently from IHS, flooded Facebook with information about MMR shots at the end of February and urged residents to get themselves and their children vaccinated.

Yet two IHS doctors said that at about the same time, the agency installed its new restrictions on vaccine-related speech.

According to a March 13 email that Ryan Goldtooth, a public information officer at one Navajo Nation hospital, sent to colleagues, members of the group had been instructed to take down social media posts or flyers that contained the terms “vaccines (namely Measles)” and “immunizations” from the agency’s Facebook pages. “We cannot forward or post to the public,” the email said.

The email also said that the terms “immunizations” and “vaccines” had been reclassified “from low to medium-risk.” As a result, if clinicians used these words in public presentations and printed materials, they needed to be cleared by a public information officer first, Goldtooth wrote.

The email listed several other topics or types of information that could no longer be freely shared or talked about publicly. Starting from the date President Donald Trump returned to office, any information shared from a state health department, for instance, had to be removed from Facebook, the email said, without providing a reason. Any posts about executive orders also had to come down.

Goldtooth, who still works for IHS, did not respond to requests for comment about the email.

Laura Hammitt, the director of infectious disease programs for the Center for Indigenous Health at Johns Hopkins Bloomberg School of Public Health, has worked closely with IHS staffers on vaccination efforts. Limiting what they can say about vaccines could harm their ability to respond to future outbreaks, she said.

“People are really trying to be compliant with changes required by the administration but also have a responsibility to care for their patients,” Hammitt said. “Those two things can seem to be at odds.”

The Navajo Nation, the country’s largest tribal jurisdiction with around 170,000 residents, has long been a focal point and challenge for IHS. The reservation is served by four of the agency’s 22 hospitals, but pockets within its 27,000 square miles of mountains and high desert have no cellphone service, internet access or electricity, creating hurdles for clinicians when it comes to communicating information and delivering care.

These structural issues had a devastating effect at the start of the pandemic, when the reservation’s rates of COVID-19 infections, hospitalizations and deaths were among the highest in the country. The virus claimed the lives of at least 2,300 Navajo citizens.

In the previous decade, vaccination rates among Navajos, especially for MMR and the flu, had regularly exceeded figures for the nation overall. They also exceeded rates for tribal communities in other regions served by IHS, which typically lagged behind the national average, according to the agency’s data. When the COVID-19 vaccine arrived in 2021, Native Americans’ uptake exceeded 60%, an effort bolstered by IHS public service messages and outreach.

On the Navajo Nation, IHS hospitals posted messages on their Facebook pages and circulated flyers that pushed community members to get the shots. “Protect yourself, protect your family, protect your elders,” the flyers said. Tribal members responded, arriving at clinics in droves, lining up in their vehicles to get vaccinated at hospitals and clinics.

For those who couldn’t travel to larger towns on the reservation that had health care facilities, teams working for IHS, the tribe and Johns Hopkins set up mobile clinics and made home visits to especially remote communities.

After the pandemic, IHS and tribal teams on the Navajo Nation sought to extend the COVID-19 shot success to routine vaccines. MMR immunization rates among 2-year-olds had dropped to 85%, but another coordinated effort restored communities on the reservation to prepandemic levels.

IHS was the engine driving the campaign, said Hammitt, the Johns Hopkins doctor. Agency flyers and Facebook posts retooled appeals used to promote COVID-19 shots to endorse the MMR vaccine, adding a call to protect “future generations.”

In the first few months of this year, however, the messaging began to morph again, with mentions of “measles” and “COVID” disappearing from IHS social media pages.

The weeks leading up to flu season and the new school year typically usher in a robust vaccine campaign in IHS hospitals. But this year, doctors took note of how few notices went out, they said, as New Mexico continued to contend with the measles outbreak that began in Texas and the Navajo Nation encountered a late-summer surge in COVID-19 cases.

One exception came in May, when IHS officials shared a New Mexico Department of Health alert on Facebook saying measles had reached Sandoval County, which overlaps with the eastern flank of the Navajo reservation. Another came that same month, when the IHS hospital in the town of Gallup, New Mexico, announced a clinic for people who wanted to get vaccinated for measles.

The IHS hospital in Shiprock, New Mexico, was the only facility to post a public service announcement about a back-to-school vaccine clinic for children. It included language telling patients to talk to doctors about their options and didn’t specifically mention measles, COVID-19 or any other infectious disease as such announcements had in the past.

Another measles outbreak surfaced in the Southwest in mid-August, this time just to the west of the Navajo Nation along the Arizona-Utah border. In early November, it had grown to at least 200 confirmed cases, according to Arizona and Utah health officials. IHS didn’t issue any advisories or notices on Facebook about this outbreak. The new approval processes for greenlighting public health alerts slowed down local administrators’ and hospitals’ response, the clinicians who spoke to ProPublica noted.

Several clinicians said the restrictions on vaccine-related speech alter the relationship between IHS doctors and patients, even if they apply only to public communications and not to one-on-one consultations.

“This is what we do for a living, and the most important thing we do is explain what’s going on to patients,” one of the doctors said. “If there is an external body interfering with that, as there is now, then that is shaping the fundamental trust between patients and the people trying to provide their care.”

The post The Indian Health Service Is Flagging Vaccine-Related Speech. Doctors Say They’re Being Censored. appeared first on ProPublica.

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