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US aid cuts are contributing to exploitation of Rohingya children

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US aid cuts are contributing to exploitation of Rohingya children

UKHIYA, Bangladesh (AP) — In moments when she is alone, when there is a break in the beatings from her husband, the girl cries for the school that was once her place of peace in a world that has otherwise offered her none.

Ever since the military in her homeland of Myanmar killed her father in 2017, forcing her to flee to neighboring Bangladesh with her mother and little sisters, the school had protected Hasina from the predators who prowl her refugee camp, home to 1.2 million members of Myanmar’s persecuted Rohingya minority.

An aerial view of a Rohingya refugee camp, home to over a million of Myanmar's persecuted Rohingya minority, is pictured in Cox's Bazar, Bangladesh, Tuesday, Nov. 25, 2025. (AP Photo/Mahmud Hossain Opu)

An aerial view of a Rohingya refugee camp, home to over a million of Myanmar’s persecuted Rohingya minority, is pictured in Cox’s Bazar, Bangladesh, Tuesday, Nov. 25, 2025. (AP Photo/Mahmud Hossain Opu)

It had also protected her from being forced into marriage. And then one day in June, when Hasina was 16 years old, her teacher announced that the school’s funding had been taken away. The school was closing. In a blink, Hasina’s education was over, and so, too, was her childhood.

With her learning opportunities gone, and her family worried that foreign aid cuts would make their fight for survival in the camps even more perilous, Hasina — along with hundreds of other girls under the age of 18 — was quickly married off. And, just like Hasina, many of the girls are now trapped in marriages with men who abuse them.

“I dreamed of being something, of working for the community,” Hasina, now 17, says softly. The Associated Press is withholding her full name to protect her from retaliation by her husband. “My life is destroyed.”

The sudden and severe foreign aid cuts imposed this year by U.S. President Donald Trump, along with funding reductions from other countries, shuttered thousands of the camps’ schools and youth training centers and crippled child protection programs. Beyond unwanted marriages, scores of children as young as 10 were forced into backbreaking manual labor, and girls as young as 12 forced into prostitution. With no safe space to play or learn, children were left to wander the labyrinthine camps, making them increasingly easy targets for kidnappers. And the young and desperate were picked off by traffickers who promised to restore what the children had lost: Hope.

In a sweltering building not far from the cramped shelter where her husband tortures her, Hasina plays nervously with the strap of her pink mobile phone case, emblazoned with the words “Forever Young.”

She is still young, she says. But the aid cuts forced her into womanhood and into a nightmare. Not long after marrying her husband, she says, he isolated her from her family and began to beat and sexually abuse her. She daydreams daily of school, where she was a whiz at English and hoped to become a teacher. Now, she is confined largely to her shelter, cooking and cleaning and waiting with dread for the next beating.

If she had any way to escape, she says, she would. But there is nowhere to go. She cannot return to Myanmar, where the military that killed thousands of Rohingya in 2017 during what the U.S. declared a genocide remains in charge of her homeland.

Now, her husband is in charge of her future, though she no longer sees one.

“If the school hadn’t closed,” she says, “I wouldn’t be trapped in this life.”

Kristen Gelineau has covered Myanmar’s persecuted Rohingya people since 2017. Her reporting has exposed atrocities committed by Myanmar’s ruling military, including systematic rape of Rohingya women and girls and widespread use of torture against civilian prisoners.

Children targeted

Life has always been dangerous for the 600,000 children languishing in these chaotic, overcrowded camps, where a squalid jumble of bamboo and tarpaulin shelters are jammed onto landslide-prone hills. But Trump’s decision in January to dismantle the U.S. Agency for International Development has made it even more so, the AP found in interviews with 37 children, family members, teachers, community leaders and aid workers.

Violations against children in the camps have risen sharply this year, according to UNICEF, the United Nations’ children’s agency. Between January and mid-November, reported cases of abduction and kidnapping more than quadrupled over the same time period last year, to 560 children. And there has been an eightfold increase in reports of armed groups’ recruitment and use of children for training and support roles in the camps, with 817 children affected. Many members of the armed groups are battling a powerful ethnic militia across the border in Myanmar. The actual number of cases is likely higher due to underreporting, according to UNICEF, which lost 27% of its funding due to the U.S. aid cuts and subsequently shuttered nearly 2,800 schools.

“The armed groups, with their roots in Myanmar, are operating in the camps, using the camps as a fertile ground for recruiting young people,” says Patrick Halton, a child protection manager for UNICEF. “Obviously, if children are not in learning centers and not in multipurpose centers, then they’re more vulnerable to this.”

Verified cases of child marriage, which the U.N. defines as the union of children under age 18, rose by 21% and verified child labor cases by 17% in the year to September, compared to the same time period last year. Those statistics are likely to be a significant undercount, says Halton.

“With the funding cuts, we had to downscale a lot in terms of the education,” Halton says. “It’s meant that children have not necessarily had things to do, and we’ve therefore seen this rise in children being married, children being in child labor.”

Though the U.S. spent just 1% of its budget on foreign aid, Trump dubbed USAID wasteful and shut it down, a move that has proven catastrophic for the world’s most vulnerable. In Myanmar, the AP found the aid cuts have caused children to starve to deathdespite U.S. Secretary of State Marco Rubio’s statement to Congress that “No one has died” because of the dissolution of USAID. A study published in The Lancet journal in June said the U.S. funding cuts could result in more than 14 million deaths, including more than 4.5 million children under age 5, by 2030.

In the Bangladesh camps, the U.S. — which has long been the biggest provider of aid to the predominantly Muslim Rohingya — slashed its funding by nearly half compared to last year. The overall Rohingya emergency response is only 50% funded for 2025, and aid agencies say next year is expected to be far worse.

In a statement to the AP, the State Department said the U.S. has provided more than $168 million to the Rohingya since the beginning of Trump’s term, although data from the U.N.’s financial tracking service show the U.S. contribution in 2025 is $156 million. Asked about the disparity, the State Department said the U.N.’s financial tracking service had not been recently updated and “generally does not show the latest information on all U.S. funding.”

The department said it had “advanced burden sharing and improved efficiency” in the Rohingya response, resulting in 11 countries increasing their funding by more than 10% year on year, collectively contributing $72 million.

“The Trump Administration continues to pursue the diplomatic efforts to encourage additional countries to help shoulder the burden,” the statement said.

The department didn’t respond to the AP’s request for evidence that the U.S. had influenced other countries’ funding decisions for the Rohingya response.

When the schools shut down, hundreds of underage girls — some as young as 14 — were married off, says Showkutara, executive director of the Rohingya Women Association for Education and Development. Her network of contacts across the camps have also reported an increase in kidnapping and trafficking, as well as a huge surge in the prostitution of girls as young as 12 since the aid cuts.

“After the school closures, they had no space to play. … That’s why they’re playing on the roads, far away from their blocks,” says Showkutara, who goes by one name. “There are some groups who are targeting the children.”

While UNICEF managed to repurpose some of its remaining funding, enabling the agency to recently reopen most of its learning centers, scores of schools run by other aid groups are still shut, and thousands of children remain out of class. And aid workers are anticipating even steeper funding cuts next year, leaving the schools’ futures uncertain. Save the Children has only secured a third of its funding target for life-saving services for 2026, meaning 20,000 children attending its schools are at risk of losing their education starting in January, says Golam Mostofa, the group’s area director for Cox’s Bazar, the closest city to the camps.

Meanwhile, Showkutara says, the children locked out of learning by the initial closures are forever lost: Both metaphorically, in the case of girls like Hasina who were married off to men who will never let them return to school even if they reopen, and literally, in the case of children who vanished into the trafficking network.

“It’s too late,” she says.

The death of dreams

The little boy sits slumped on a plastic stool under the punishing sun, his cheeks streaked with sweat, a cooler of freeze pops and other treats at his dirty feet. Ever since 10-year-old Mohammed Arfan’s school closed, this is where he spends 10 hours a day, seven days a week, selling snacks and daydreaming of the small schoolroom where he once felt safe and loved.

He had just finished his math lessons the day that his teacher told him the school’s funding was gone. As he walked home, he and his friends began to cry.

“I thought that I would not see my friends anymore, and that I was losing my future,” he says.

Ten-year-old Rohingya refugee Mohammed Arfan, left, sells snacks inside the Rohingya refugee camp in Cox's Bazar, Bangladesh, Friday, Nov. 21, 2025. (AP Photo/Mahmud Hossain Opu)

Ten-year-old Rohingya refugee Mohammed Arfan, left, sells snacks inside the Rohingya refugee camp in Cox’s Bazar, Bangladesh, Friday, Nov. 21, 2025. (AP Photo/Mahmud Hossain Opu)

With no lessons to occupy his time, and his parents worried about their seven children’s survival, Arfan’s mother told him he would need to work to help keep the family fed.

He was terrified. If the camp’s kidnappers or thieves targeted him while he was working, he knew he was too small to fight back.

But he had no choice, and so his daily drudgery began. Each morning, he wakes at 7 and walks for half an hour to the factory to pick up the treats. Then, hoisting the 15-kilogram (30-pound) cooler upon his bony shoulder, he walks another 30 minutes to the corner of the dusty road where he sets up shop among the garbage, rotting banana peels and swarms of flies. For his efforts, he takes home around 200 to 300 taka ($1.60 to $2.50) a day.

There are boys like Arfan all over the camps, selling food they’re desperate to eat and collecting trash in exchange for cash, shoulders slumped with exhaustion, skin seared by the sun.

In a drainage ditch next to a row of stinking latrines, 13-year-old Rahamot Ullah wades up to his waist in water clouded with raw sewage, plucking from the muck discarded pieces of plastic. Five hours of rummaging through the waste will generally net him enough plastic to trade for around 50 taka (40 cents).

His eye blazes with blood from the bamboo that pierced it 10 days earlier while slogging through the sewage. He began coming here soon after his school shut down, in the hopes he could collect enough trash to pay the 500 taka ($4) a month fee for private lessons. Many months, that fee has remained out of reach.

He worries he will drown in the ditch. And he worries that his dreams of becoming a camp official or a teacher will never come true.

Thirteen-year-old Rohingya refugee Rahamot Ullah collects plastic waste from a drainage canal inside the Rohingya refugee camp in Cox's Bazar, Bangladesh, Saturday, Nov. 22, 2025. (AP Photo/Mahmud Hossain Opu)

Thirteen-year-old Rohingya refugee Rahamot Ullah collects plastic waste from a drainage canal inside the Rohingya refugee camp in Cox’s Bazar, Bangladesh, Saturday, Nov. 22, 2025. (AP Photo/Mahmud Hossain Opu)

Back on the street corner, Arfan, too, feels his dreams dying. He shouldn’t be here, he says, voice barely audible above the incessant shrieking of horns from the rickshaws racing past, just inches from his cooler.

“I feel shame working,” he says. “This is the time I should be studying.”

Each night when the sun sets, Arfan packs up and heads back to his shelter. And it is here where he lies on a mat on the bamboo floor, crying himself to sleep and pining for the life he was forced to leave behind.

‘My heart is still crying’

The laughter that once filled Noor Zia’s classroom has been replaced by tears. Nearly every day, she says, her former students stop by to see if the school has reopened, only to break down when told it has not.

Zia often finds herself in tears, too. Before the aid cuts, she was the head teacher of 21 early learning centers that served 630 children aged 3-5. But the closures left her without a job, making it even harder for her to keep her family alive on the camp’s meager rations.

“My heart is still crying, because my family depends on this job,” she says, sitting in the empty classroom, where the wall behind her is adorned with a drawing of the Myanmar flag — a country most of her students, born in the camps, have never seen.

The funding cuts’ pain goes beyond the school closures. Skills development programs that kept thousands of children occupied were also halted. Healthcare, nutrition and sanitation services have been reduced. In camps crawling with scabies and other diseases, the results of the reductions are clear on the children’s scrawny bodies. Lesions line their slender limbs. The wet, rattling coughs of babies fill the fetid air. Atop a muddy hill, clusters of kids scratch ferociously at their heads, while a 4-year-old stoically plucks nits from her friend’s scalp.

Bangladesh has barred the Rohingya from leaving the camps to find work, so they are reliant upon humanitarian aid to survive. But the U.N.’s World Food Program, which had counted the U.S. as its largest donor, says it only has enough funds to continue providing food rations through March.

The prospect of a ration cut has terrified families. With no country offering the Rohingya large-scale resettlement, many have opted to make a run for it, with devastating results. Nearly a third of the 1,340 Rohingya who have fled Bangladesh by boat this year have died or gone missing en route, according to the U.N. High Commissioner for Refugees.

Noor Kaida, a 17-year-old whose dreams of becoming a doctor were dashed when she was married off after her school shut, says she has lost two young relatives to traffickers. Shattered by the school closures, the 13- and 16-year-old girls believed traffickers who promised them a better life in Malaysia, Kaida says. Other passengers on the girls’ boats later told Kaida’s family both girls were killed; one by drowning, and the other at the hands of a trafficker.

“If the school wasn’t closed, they wouldn’t have had to take these risks,” Kaida says. “Because of the funding cuts and the school closures, thousands of girls were scattered in different places and their lives have been ruined.”

’Pray for me’

The 13-year-old boy had been missing for nine days when the call came in from an unfamiliar number.

“Baba, I’m leaving,” Mohammed told his frantic father. “I’m on the big boat now. Pray for me.”

The call disconnected, and Mohib Ullah knew his worst nightmare had come true: Just like so many other children in recent months, his boy had been taken by traffickers. Ullah — who has no relation to Rahamot Ullah — called back again and again, but the phone was switched off.

Mohammed — whose full name the AP is withholding for safety reasons — had been miserable since his school closed. The kindhearted boy who loved to read and learn, especially English, had long dreamed of becoming a teacher. When his education ended, he told his father through tears that his life was over. Ullah promised to try and find money for private school, but as a widower caring for four children, it was impossible.

Brown sandals of 13-year-old Mohammed are propped against the wall, alongside sparkly pink sneakers belonging to his sister, inside their shelter in the Rohingya refugee camp in Cox's Bazar, Bangladesh, Saturday, Nov. 22, 2025. (AP Photo/Mahmud Hossain Opu)

Brown sandals of 13-year-old Mohammed are propped against the wall, alongside sparkly pink sneakers belonging to his sister, inside their shelter in the Rohingya refugee camp in Cox’s Bazar, Bangladesh, Saturday, Nov. 22, 2025. (AP Photo/Mahmud Hossain Opu)

The teen hatched a plan, which he shared in secret with his big sister, Bibi: He would go with a trafficker to Malaysia, and find a future there. Bibi tried to talk him out of it; traffickers who take children on the long, dangerous journey generally detain the youngsters at the end until their parents pay a fee for their release. The children of parents who can’t pay are often tortured, and sometimes killed. Bibi warned her brother that their father would never be able to afford the trafficker’s payment.

But Mohammed didn’t care. “It’s better to withstand two years of torture than stay here in a hopeless camp,” he told his sister. “It’s better to die if I can’t continue learning.”

In a panic, Bibi shared her brother’s plan with their father, who was horrified; he knew how deadly the journey to Malaysia can be. He ordered his son to stay put, and to stay patient. The schools will reopen someday, he assured Mohammed. But the teen was convinced they would not.

And so, one morning in October, Mohammed left his family’s shelter and never returned. Ullah scoured the camps and called relatives, searching for any trace of his son. He couldn’t sleep, couldn’t eat. He has already lost another son, an 8-year-old who suddenly died on the anniversary of Ullah’s wife’s death, after crying all day about missing his mother and then saying he felt unwell. The prospect of losing one more child was unbearable.

Mohammed’s call came on Oct. 21. And then, for over six weeks, there was silence.

On Dec. 6, Ullah’s phone finally rang. It was Mohammed — still alive, but sick and sobbing. The traffickers were demanding 380,000 taka ($3,100) for his release — an astronomical sum that Ullah told Mohammed he did not have. But the terrified boy begged his father to try and find it.

Ullah knew if couldn’t, his son would likely be killed. And so he pleaded with anyone he could think of for any money they could spare. In the end, he collected just enough, and Mohammed was set free in Malaysia.

Ullah does not know what will become of his boy, who is still so young and wandering around a country that is alien to him.

“If he could have continued his studies, he could have been a teacher, he could have stayed near me,” Ullah says, blinking back tears. “Now he’s left me and I can’t see him. So I lost my dream, too.”

His voice cracks as he describes what was long one of his greatest joys: The sight of his son coming home from school, backpack slung across his shoulders.

Now, the stacks of workbooks Mohammed once pored over sit in his bedroom, untouched. His brown sandals are propped against the wall, alongside the sparkly pink sneakers belonging to the sister who tried in vain to stop him.

And, hanging from a piece of bamboo, gathering dust, is his backpack.

—-

Contact AP’s global investigative team at [email protected] or https://www.ap.org/tips/.

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The Dictatorship

Trump signs executive order to protect Venezuelan oil revenue

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Trump signs executive order to protect Venezuelan oil revenue

WEST PALM BEACH, Fla. (AP) — President Donald Trump’s new executive order on Venezuelan oil revenue is meant to ensure that the money remains protected from being used in judicial proceedings.

The executive order, made public on Saturday, says that if the funds were to be seized for such use, it could “undermine critical U.S. efforts to ensure economic and political stability in Venezuela.”

The order comes amid caution from top oil company executives that the tumult and instability in Venezuela could make the country less attractive for private investment and rebuilding.

“If we look at the commercial constructs and frameworks in place today in Venezuela, today it’s uninvestable,” said Darren Woods, CEO of ExxonMobil, the largest U.S. oil company, during a meeting convened by Trump with oil executives on Friday.

During the session, Trump tried to assuage the concerns of the oil companies and said the executives would be dealing directly with the U.S., rather than the Venezuelan government.

Venezuela has a history of state asset seizures, ongoing U.S. sanctions and decades of political uncertainty.

Getting U.S. oil companies to invest in Venezuela and help rebuild the country’s infrastructure is a top priority of the Trump administration after the dramatic capture of now-deposed leader Nicolás Maduro.

The White House is framing the effort to “run” Venezuela in economic terms, and Trump has seized tankers carrying Venezuelan oil, has said the U.S. is taking over the sales of 30 million to 50 million barrels of previously sanctioned Venezuelan crude, and plans to control sales worldwide indefinitely.

“I love the Venezuelan people, and am already making Venezuela rich and safe again,” Trump, who is currently in southern Florida, wrote on his social media site on Saturday. “Congratulations and thank you to all of those people who are making this possible!!!”

The order says the oil revenue is property of Venezuela that is being held by the United States for “governmental and diplomatic purposes” and not subject to private claims.

Its legal underpinnings are the National Emergencies Act and the International Emergency Economic Powers Act. Trump, in the order, says the possibility that the oil revenues could be caught up in judicial proceedings constitutes an “unusual and extraordinary threat” to the U.S.

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The Dictatorship

Trump pushes a 1-year, 10% cap on credit card interest rates. Banks balk

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Trump pushes a 1-year, 10% cap on credit card interest rates. Banks balk

NEW YORK (AP) — Reviving a campaign pledge, President Donald Trump wants a one-year, 10% cap on credit card interest rates, a move that could save Americans tens of billions of dollars but drew immediate opposition from an industry that has been in his corner.

Trump was not clear in his social media post Friday night whether a cap might take effect through executive action or legislation, though one Republican senator said he had spoken with the president and would work on a bill with his “full support.” Trump said he hoped it would be in place Jan. 20, one year after he took office.

Strong opposition is certain from Wall Street in addition to the credit card companies, which donated heavily to his 2024 campaign and have supported Trump’s second-term agenda. Banks are making the argument that such a plan would most hurt poor people, at a time of economic concern, by curtailing or eliminating credit lines, driving them to high-cost alternatives like payday loans or pawnshops.

“We will no longer let the American Public be ripped off by Credit Card Companies that are charging Interest Rates of 20 to 30%,” Trump wrote on his Truth Social platform.

Researchers who studied Trump’s campaign pledge after it was first announced found that Americans would save roughly $100 billion in interest a year if credit card rates were capped at 10%. The same researchers found that while the credit card industry would take a major hit, it would still be profitable, although credit card rewards and other perks might be scaled back.

About 195 million people in the United States had credit cards in 2024 and were assessed $160 billion in interest charges, the Consumer Financial Protection Bureau says. Americans are now carrying more credit card debt than ever, to the tune of about $1.23 trillion, according to figures from the New York Federal Reserve for the third quarter last year.

Further, Americans are paying, on average, between 19.65% and 21.5% in interest on credit cards according to the Federal Reserve and other industry tracking sources. That has come down in the past year as the central bank lowered benchmark rates, but is near the highs since federal regulators started tracking credit card rates in the mid-1990s. That’s significantly higher than a decade ago, when the average credit card interest rate was roughly 12%.

The Republican administration has proved particularly friendly until now to the credit card industry.

Capital One got little resistance from the White House when it finalized its purchase and merger with Discover Financial in early 2025, a deal that created the nation’s largest credit card company. The Consumer Financial Protection Bureau, which is largely tasked with going after credit card companies for alleged wrongdoing, has been largely nonfunctional since Trump took office.

In a joint statement, the banking industry was opposed to Trump’s proposal.

“If enacted, this cap would only drive consumers toward less regulated, more costly alternatives,” the American Bankers Association and allied groups said.

Bank lobbyists have long argued that lowering interest rates on their credit card products would require the banks to lend less to high-risk borrowers. When Congress enacted a cap on the fee that stores pay large banks when customers use a debit card, banks responded by removing all rewards and perks from those cards. Debit card rewards only recently have trickled back into consumers’ hands. For example, United Airlines now has a debit card that gives miles with purchases.

The U.S. already places interest rate caps on some financial products and for some demographics. The Military Lending Act makes it illegal to charge active-duty service members more than 36% for any financial product. The national regulator for credit unions has capped interest rates on credit union credit cards at 18%.

Credit card companies earn three streams of revenue from their products: fees charged to merchants, fees charged to customers and the interest charged on balances. The argument from some researchers and left-leaning policymakers is that the banks earn enough revenue from merchants to keep them profitable if interest rates were capped.

“A 10% credit card interest cap would save Americans $100 billion a year without causing massive account closures, as banks claim. That’s because the few large banks that dominate the credit card market are making absolutely massive profits on customers at all income levels,” said Brian Shearer, director of competition and regulatory policy at the Vanderbilt Policy Accelerator, who wrote the research on the industry’s impact of Trump’s proposal last year.

There are some historic examples that interest rate caps do cut off the less creditworthy to financial products because banks are not able to price risk correctly. Arkansas has a strictly enforced interest rate cap of 17% and evidence points to the poor and less creditworthy being cut out of consumer credit markets in the state. Shearer’s research showed that an interest rate cap of 10% would likely result in banks lending less to those with credit scores below 600.

The White House did not respond to questions about how the president seeks to cap the rate or whether he has spoken with credit card companies about the idea.

Sen. Roger Marshall, R-Kan., who said he talked with Trump on Friday night, said the effort is meant to “lower costs for American families and to reign in greedy credit card companies who have been ripping off hardworking Americans for too long.”

Legislation in both the House and the Senate would do what Trump is seeking.

Sens. Bernie Sanders, I-Vt., and Josh Hawley, R-Mo., released a plan in February that would immediately cap interest rates at 10% for five years, hoping to use Trump’s campaign promise to build momentum for their measure.

Hours before Trump’s post, Sanders said that the president, rather than working to cap interest rates, had taken steps to deregulate big banks that allowed them to charge much higher credit card fees.

Reps. Alexandria Ocasio-Cortez, D-N.Y., and Anna Paulina Luna, R-Fla., have proposed similar legislation. Ocasio-Cortez is a frequent political target of Trump, while Luna is a close ally of the president.

___

Seung Min Kim reported from West Palm Beach, Fla.

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The Dictatorship

Changes to the US vaccine recommendations are sowing confusion and could harm kids

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Changes to the US vaccine recommendations are sowing confusion and could harm kids

Dr. Molly O’Shea has noticed growing skepticism about vaccines at both of her Michigan pediatric offices and says this week’s unprecedented and confusing changes to federal vaccine guidance will only make things worse.

One of her offices is in a Democratic area, where more of the parents she sees are opting for alternative schedules that spread out shots. The other is in a Republican area, where some parents have stopped immunizing their children altogether.

She and other doctors fear the new recommendations and the terminology around them will stoke vaccine hesitancy even more, pose challenges for pediatricians and parents that make it harder for kids to get shots, and ultimately lead to more illness and death.

The biggest change was to stop blanket recommendations for protection against six diseases and recommend those vaccines only for at-risk children or through something called “shared clinical decision-making” with a health care provider.

The phrase, experts say, is confusing and dangerous: “It sends a message to a parent that actually there’s only a rarefied group of people who really need the vaccine,” O’Shea said. “It’s creating an environment that puts a sense of uncertainty about the value and necessity or importance of the vaccines in that category.”

Health Secretary Robert F. Kennedy Jr.who helped lead the anti-vaccine movement for years, said in announcing the changes that they better align the U.S. with peer nations “while strengthening transparency and informed consent.”

But doctors say they are sowing doubt — the vaccines have been extensively studied and proven to be safe and effective at shielding kids from nasty diseases — at a time when childhood vaccination rates are already falling and some of those infectious diseases are spreading.

On Friday, the American Academy of Pediatrics and more than 200 medical, public health and patient advocacy groups sent a letter to Congress about the new childhood immunization schedule.

“We urge you to investigate why the schedule was changed, why credible scientific evidence was ignored, and why the committee charged with advising the HHS Secretary on immunizations did not discuss the schedule changes as a part of their public meeting process,” they wrote.

Many don’t know what ’shared decision-making’ means

O’Shea said she and other pediatricians discuss vaccines with parents at every visit where they are given. But that’s not necessarily “shared clinical decision-making,” which has a particular definition.

On its website, the Advisory Committee on Immunization Practices says: “Unlike routine, catch-up, and risk-based recommendations, shared clinical decision-making vaccinations are not recommended for everyone in a particular age group or everyone in an identifiable risk group. Rather, shared clinical decision-making recommendations are individually based and informed by a decision process between the health care provider and the patient or parent/guardian.”

In this context, health care providers include primary care physicians, specialists, physician assistants, nurse practitioners, registered nurses and pharmacists.

A pair of surveys conducted last year by the Annenberg Public Policy Center at the University of Pennsylvania suggested that many people don’t fully understand the concept, which came up last year when the federal government changed recommendations around COVID-19 vaccinations.

Only about 2 in 10 U.S. adults knew that one meaning behind shared decision-making is that “taking the vaccine may not be a good idea for everyone but would benefit some.” And only about one-third realized pharmacists count as health care providers to talk with during the process, even though they frequently administer vaccines.

As of this week, vaccines that protect against hepatitis A, hepatitis B, rotavirus, RSV, flu and meningococcal disease are no longer universally recommended for kids. RSV, hepatitis A, hepatitis B and meningococcal vaccines are recommended for certain high-risk populations; flu, rotavirus, hepatitis A, hepatitis B and meningococcal vaccines are recommended through shared decision-making — as is the COVID-19 vaccine, although that change was made last year.

Shortly after the federal announcement Monday, Dr. Steven Abelowitz heard from half a dozen parents. “It’s causing concern for us, but more importantly, concern for parents with kids, especially young kids, and confusion,” said Abelowitz, founder of Ocean Pediatrics in Orange County, California.

Though federal recommendations are not mandates — states have the authority to require vaccinations for schoolchildren — they can affect how easy it is for kids to get shots if doctors choose to follow them.

Under the new guidelines, O’Shea said, parents seeking shots in the shared decision-making category might no longer bring their kids in for a quick, vaccine-only appointment with staff. They’d sit down with a health care provider and discuss the vaccine. And it could be tougher to have a flu clinic, where parents drive up and kids get shots without seeing a doctor.

Staying the course as challenges mount

Still, doctors say they won’t let the changes stop them from helping children get the vaccines they need. Leading medical groups are sticking with prior vaccine recommendations. Many parents are, too.

Megan Landry, whose 4-year-old son Zackary is one of O’Shea’s patients, is among them.

“It’s my responsibility as a parent to protect my child’s health and well-being,” she said. “Vaccines are a really effective and well-studied way to do that.”

She plans to keep having the same conversations she’s always had with O’Shea before getting vaccines for Zackary.

“Relying on evidence and trusted medical guidance really helps me to make those decisions,” she said. “And for me, it’s not just a personal choice for my own son but a way to contribute to the health of everybody.”

But for other families, confidence about vaccines is waning as trust in science erodes. O’Shea lamented that parents are getting the message that they can’t trust medical experts.

“If I take my car to the mechanic, I don’t go do my own research ahead of time,” she said. “I go to a person I trust and I trust them to tell me what’s going on.”

Abelowitz, the California doctor, likened the latest federal move to pouring gasoline on a fire of mistrust that was already burning.

“We’re worried the fire’s out of control,” he said. “Already we’ve seen that with measles and pertussis, there are increased hospitalizations and even increasing deaths. So the way that I look at it — and my colleagues look at it — we’re basically regressing decades.”

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