The National Institutes of Health (NIH) is abruptly terminating at least 33 research grants for projects studying why some people are hesitant to receive vaccines or evaluating strategies that could encourage vaccine uptake, Science has learned. An additional nine grants may be modified or cut back. Scientists who received these grants began to receive termination letters this evening.

A person with direct knowledge of the situation says NIH has also requested lists of projects involving messenger RNA (mRNA) vaccines, which some vaccine skeptics think are unsafe because they believe, without evidence, that the vaccines could modify DNA or cause various health issues. The agency is also seeking a list of collaborations between NIH researchers and international partners on any topic. The terminations appear to be part of the agency’s efforts to defund research that does not align with policies backed by President Donald Trump and Department of Health and Human Services Secretary Robert F. Kennedy Jr.—a noted vaccine skeptic.

Last week, on behalf of interim Director Matthew Memoli, NIH asked each of its institutes to supply a list of current and future grants involving vaccine hesitancy. This morning, officials at the institutes sent a list of grants to be terminated to program officers, along with a template letter notifying awardees their grant was being terminated as of 11 March.

The letter, which Science has seen, will inform investigators that their award “no longer effectuates agency priorities. It is the policy of NIH not to prioritize research activities that focus on gaining scientific knowledge on why individuals are hesitant to be vaccinated and/or explore ways to improve vaccine interest and commitment.”

Like letters sent last week to dozens of researchers studying transgender health, the new termination letter says researchers should not try to alter their projects to conform to the new policy because “the premise of Project Number [INSERT] is incompatible with agency priorities, and no modification of the project could align the project with agency priorities.”

Fourteen of the awards are funded by the National Institute of Allergy and Infectious Diseases and involve vaccines for diseases such as mpox, human papillomavirus, chickenpox, and COVID-19. One involves a hypothetical gonorrhea vaccine. The project appeared on the list because one of its aims “is to evaluate health care worker’s [sic] and potential patient’s attitudes towards acceptance of a gonorrhea vaccine if one is developed.”

The list also names grants from the National Institute of Child Health and Human Development, National Institute of Mental Health, and National Institute of General Medical Sciences. Many of these involve promoting vaccine uptake among racial minority groups or understanding why some parents are reluctant to accept childhood and adolescent vaccines. In several grants, which fund efforts to model disease outbreaks, “vaccine hesitancy” is just one of several variables driving a model. It’s unclear whether these grants will be terminated in their entirety or modified so they no longer consider vaccine hesitancy. Other grants, including one that studies HIV in adolescents, will not be cut in their entirety, but subprojects involving vaccine hesitancy will be terminated.

Denis Nash, an epidemiologist at the City University of New York whose grant is on the list but who has not yet received a termination letter, says it will affect his work testing vaccine messaging strategies for people with mental health disorders and studying barriers such as misinformation and disinformation. “Ceasing to support research on the uptake of safe and effective vaccines does not eliminate the underlying challenges related to low vaccine uptake—it exacerbates them,” he says.

Another $548,002 project that has been terminated is analyzing electronic health records and infant developmental screening data to study whether the COVID-19 vaccine is safe in people who are pregnant or breastfeeding. The grant’s primary investigator, perinatal epidemiologist Kristin Palmsten at the HealthPartners Institute, says she was “stunned” by the 10 March termination notice. “The grant does not study vaccine hesitancy or uptake,” Palmsten says. “I originally wrote this grant because I was breastfeeding my daughter around the time of COVID-19 vaccine rollout, and there was no available human data on the safety of COVID-19 vaccination during breastfeeding.”

Palmsten says one reason for the project was to identify potential harms that would be important for patients’ decision-making. “I know how terrible it feels to have zero safety data available,” she says.

Thomas Carpino, an epidemiology graduate student at Johns Hopkins University, learned that the $48,974 training grant supporting his Ph.D. work on mpox among men who have sex with men is being canceled. Carpino had already defended his thesis and has a postdoc position lined up, but he will need alternative funding to finish his study. The grant was “to train the next generation of public health scientists,” he says. “They’re sending a very strong message to anyone who’s interested in pursuing these research topics.”

A second memo sent to the institutes on 6 March and seen by Science said Memoli “has requested information on NIH’s investment in mRNA vaccines research” including current or planned grants and contracts. A third asked the institutes to provide “information on each current substantive collaboration between your [Institute or Center] or [Intramural Research] program and international partners (nongovernmental organizations, research institutions, governments).” Collaboration could mean sharing data, providing technical assistance or training, or participating in working groups and advisory groups. NIH institutes and programs must respond by next week.

Measles outbreaks in West Texas and New Mexico are now up to more than 250 cases, and two unvaccinated people have died from measles-related causes.

Measles is caused by a highly contagious virus that’s airborne and spreads easily when an infected person breathes, sneezes or coughs. It is preventable through vaccines, and has been considered eliminated from the U.S. since 2000.

Here’s what you need to know about measles in the U.S.

How many measles cases are there in Texas and New Mexico?

Texas state health officials said Tuesday there were 25 new cases of measles since the end of last week, bringing Texas’ total to 223. Twenty-nine people in Texas are hospitalized.

New Mexico health officials announced three new cases Tuesday, bringing the state’s total to 33. The outbreak has spread from Lea County, which neighbors the West Texas communities at the epicenter of the outbreak, to include one case in Eddy County.

Oklahoma’s state health department reported two probable cases of measles Tuesday, saying they are “associated” with the West Texas and New Mexico outbreaks.

A school-age child died of measles in Texas last month, and New Mexico reported its first measles-related death in an adult last week.

Where else i

s measles showing up in the U.S.?

Measles cases have been reported in Alaska, California, Florida, Georgia, Kentucky, Maryland, New Jersey, New York, Pennsylvania, Rhode Island and Vermont.

The U.S. Centers for Disease Control and Prevention defines an outbreak as three or more related cases — and there have been three clusters that qualified as outbreaks in 2025.

In the U.S., cases and outbreaks are generally traced to someone who caught the disease abroad. It can then spread, especially in communities with low vaccination rates.

Do you need an MMR booster?

The best way to avoid measles is to get the measles, mumps and rubella (MMR) vaccine. The first shot is recommended for children between 12 and 15 months old and the second between 4 and 6 years old.

People at high risk for infection who got the shots many years ago may want to consider getting a booster if they live in an area with an outbreak, said Scott Weaver with the Global Virus Network, an international coalition. Those may include family members living with someone who has measles or those especially vulnerable to respiratory diseases because of underlying medical conditions.

Adults with “presumptive evidence of immunity” generally don’t need measles shots now, the CDC said. Criteria include written documentation of adequate vaccination earlier in life, lab confirmation of past infection or being born before 1957, when most people were likely to be infected naturally.

A doctor can order a lab test called an MMR titer to check your levels of measles antibodies, but health experts don’t always recommend this route and insurance coverage can vary.

Getting another MMR shot is harmless if there are concerns about waning immunity, the CDC says.

People who have documentation of receiving a live measles vaccine in the 1960s don’t need to be revaccinated, but people who were immunized before 1968 with an ineffective measles vaccine made from “killed” virus should be revaccinated with at least one dose, the agency said. That also includes people who don’t know which type they got.

What are the symptoms of measles?

Measles first infects the respiratory tract, then spreads throughout the body, causing a high fever, runny nose, cough, red, watery eyes and a rash.

The rash generally appears three to five days after the first symptoms, beginning as flat red spots on the face and then spreading downward to the neck, trunk, arms, legs and feet. When the rash appears, the fever may spike over 104 degrees Fahrenheit, according to the CDC.

How can you treat measles?

There’s no specific treatment for measles, so doctors generally try to alleviate symptoms, prevent complications and keep patients comfortable.

Why do vaccination rates matter?

In communities with high vaccination rates — above 95% — diseases like measles have a harder time spreading through communities. This is called “herd immunity.”

But childhood vaccination rates have declined nationwide since the pandemic and more parents are claiming religious or personal conscience waivers to exempt their kids from required shots.

The U.S. saw a rise in measles cases in 2024, including an outbreak in Chicago that sickened more than 60. Five years earlier, measles cases were the worst in almost three decades in 2019.

Pharmacy benefits managers, or PBMs, are meant to lower drug prices by acting as a middleman between drug manufacturers and either insurance companies or employers who sponsor health plans. Advocates said employers and consumers often don’t understand what PBMs are and how they work.

Prescription Benefits Matter is a new educational campaign looking to change that.

Joey Fox has testified on behalf of the Association of Health Plans and the Pharmaceutical Care Management Association. He also directs the campaign, which he said is designed for people to better understand the role PBMs play in the price they pay at the pharmacy counter.

“It’s a part of the health care system that consumers don’t necessarily interact with on a personal level every day,” Fox said. “We want them to know that we are involved. And we are advocating for them and want them to have a better understanding of the value that they’re getting.”

By taking over that role in the negotiating process, Fox said PBMs can provide expertise to employers who cover their employee’s health insurance.

“If you are an employer in Indiana and you decide that you want to cover prescription drugs for your employees, you don’t have the expertise to call every single drug company, all the pharmacies to figure out which drugs to cover, which ones to maybe not, how much to pay for them, how much to reimburse a pharmacy,” Fox said. “The expertise within these organizations are what they’re offering to employers and to consumers to health plans.”

In addition to negotiating for drug prices, PBMs also play a role in how pharmacies actually run.

“They also are the technological backbone of the transactions that happen when you go to the pharmacy counter and pick up your drugs,” Fox said. “All that technology in the background is supplied through a pharmacy benefit manager.”

Fox said PBMs are also behind concepts like getting prescriptions delivered through the mail.

He said there are a lot of things about PBMs that people don’t understand that this campaign is hoping to answer.

“When you sign up at your at your job for health benefits, you just know, ‘OK, I’ve got I’ve got health care coverage and I know they cover prescription drugs.’ But you don’t necessarily know what that entity that’s there has been doing on your behalf or what value they add,” Fox said.

Ultimately, Fox said the main function of PBMs is to negotiate for lower drug prices for consumers.

However, some Indiana lawmakers have questioned whether PBMs are effective at achieving lower prices. In fact, lawmaker skepticism led to some of the most “aggressive” reforms being approved by the Senate earlier this legislative session.

Senate Bill 140 implements a variety of reforms meant to address concerns about what’s known as vertical integration. Vertical integration refers to when one company owns multiple parts of a certain supply chain, such as a company owning all or part of a PBM, a pharmacy and a drug manufacturer.

Under the bill, PBMs would be prohibited from working with an insurance company that has ownership interest in the PBM. And PBMs would not be allowed to have an ownership interest in a pharmacy.

Fox said Prescription Benefits Matter is targeting consumers and employers — not members of the General Assembly.

“This is really about getting to Hoosier consumers and Hoosier employers so that they understand that the prescription benefit manager is in the room advocating for them,” Fox said. “Then, they can take actions that they might deem appropriate to ensure that those benefits are protected.”

That campaign will focus on connecting people to information that Fox said already shows Hoosiers are saving about $1,000 per year because of PBMs.

“We’ve launched PrescriptionBenefitsMatter.org and an affiliated blog with kind of PBM fast facts,” Fox said. “These are ways for consumers to learn what those PBMs are doing for them on a day-to-day basis and the value that they provide.”

Fox said the campaign will include digital, print and radio advertising aimed at helping people understand that having a PBM involved in the health care system saves people money.

Health insurers’ use of AI is bringing a new level of concern to the burdensome payer cost-control practice known as prior authorization. In a recently released AMA survey (PDF), 61% of physicians said they fear that payers’ use of unregulated AI is increasing prior authorization denials, a practice that will override good medical judgment and exacerbate patient harm.

“Emerging evidence shows that insurers use automated decision-making systems to create systematic batch denials with little or no human review, placing barriers between patients and necessary medical care,” said AMA President Bruce A. Scott, MD, reacting to the survey results.

Physicians should be able to make medical decisions with their patients without interference from unregulated and unsupervised AI technology, said Dr. Scott. The AMA is fighting by challenging insurance companies to eliminate care delays, patient harms and practice hassles.

Health plans use prior authorization to control costs, requiring advance approval to obtain a prescription medication or medical service for a patient. Physicians and patients alike view this as a burdensome practice that affects care delivery, clinical outcomes and productivity in physician offices. Spending rises under this practice due to additional office visits, unanticipated hospital stays, and out-of-pocket costs for treatment.

In this most recent nationwide survey of 1,000 practicing physicians—400 working in primary care, the remainder in other physician specialties—82% reported that prior authorization sometimes leads to patients abandoning treatment. Over 90% said prior authorization delays care.

AI tools have been accused of producing high rates of care denial, in some cases 16 times higher than is typical, according to figures from a 2024 Senate committee report cited in the AMA’s news release.

“Using AI-enabled tools to automatically deny more and more needed care is not the reform of prior authorization physicians and patients are calling for,” said Dr. Scott.

Other AMA surveys underscore physician concerns about some misuses of health care AI. Results released early in February (PDF) found that 49% of physicians ranked oversight of payers’ use of AI in medical necessity determinations among the top three priorities for regulatory action. To address these concerns, the AMA House of Delegates recently adopted policy supporting advocacy to help ensure that technology is an asset to physicians and not a burden. Based on this policy, the AMA has developed advocacy principles (PDF) that address the development, deployment and use of health care AI, with particular emphasis on:

• Health care AI oversight.
• When and what to disclose to advance AI transparency.
• Generative AI policies and governance.
• Physician liability for use of AI-enabled technologies.
• AI data privacy and cybersecurity.
• Payer use of AI and automated decision-making systems.

AI concerns notwithstanding, physicians continue to report that prior authorization impedes delivery of necessary medical treatments, jeopardizes quality care and harms patients. More than nine in 10 physicians—94%—reported that prior authorization had a negative impact on clinical outcomes.

Eighty percent of doctors surveyed said that prior authorization sometimesleads patients to pay out-of-pocket for a medication, and 31% said payers are rarely or never using evidence-based criteria to make coverage decisions.

More distressingly, 29% of physicians reported that prior authorization led to a serious adverse event for a patient in their care.

More specifically, these shares of physicians said that prior authorization led to:

• A patient’s hospitalization—23%.
• A life-threatening event, or one that required intervention to prevent permanent damage—18%.
• A patient’s disability, permanent bodily damage, congenital anomaly, birth defect or death—8%.

Physicians also feel the administrative burden of prior authorization, which reduces their time with patients and negatively affects their practices. On average, physicians and their staff spend 13 hours a week completing the prior authorization workload for a single physician. Forty percent of physicians employ staff whose primary job is to work on this task.

These shares of physician respondents also revealed that prior authorization:

• Somewhat or significantly increases physician burnout—89%.
• Has increased somewhat or significantly over the last five years—75%.
• Is often or always denied—31%.

In cases of adverse payer decisions on prior authorization requests, 20% of physicians will always appeal. Physicians report various reasons for not appealing health-plan denials, with 67% reported doubts about an appeal’s success based on their past experiences. Over half said patient care could not wait for the health plan’s approval process, and 55% said they had insufficient resources to file an appeal.

The survey also revealed that prior authorization adds significant costs to the U.S. health system, forcing patients to try ineffective treatments and schedule additional office visits.

A strong majority of physicians—88%—reported that prior authorization leads to higher overall utilization of health care resources. These shares of physicians reported that prior authorization increases utilization in the following ways:

• Led to ineffective initial treatment—77%.
• Additional office visits—73%.
• Immediate care or emergency department visits—47%.
• Hospitalizations—33%.

Prior authorization can also affect productivity in the workplace, if employees are missing work due to delays in care leading to prolonged illness or attending rescheduled appointments. Nearly 60% of physicians with patients in the workforce said prior authorization has affected work performance among their patients.

Back in 2018, the AMA joined the American Hospital Association, American Pharmacists Association, Medical Group Management Association, America’s Health Insurance Plans, and Blue Cross Blue Shield Association in releasing a consensus statement (PDF) on how to improve prior authorization.

Seven years later, surveyed physicians reported that health plans have made little progress honoring their commitments as outlined in that document. Major payers such as UnitedHealthcare and Cigna pledged to reduce services requiring prior authorization in 2023. But just 16% of physicians who work with UnitedHealthcare and Cigna, respectively, reported that the changes led to a reduction in prior authorization requirements.

There has been some momentum to fix prior authorization at the state and federal levels. States enacted 13 prior authorization reform bills last year to cut the volume of prior authorization requirements, reduce patient care delays, improve transparency surrounding prior authorization rules and increase prior authorization data reporting.

At the federal level, the Centers for Medicare & Medicaid Services last year issued a final rule that included prior authorization reforms designed to cut patient-care delays and electronically streamline the process for physicians.

However, the continuing resolution that Congress passed in late 2024 to keep the federal government operating into 2025 failed to include prior authorization reform in the final package—a reform with vast bipartisan support in both chambers. The AMA and others are calling for five critical reforms, including speeding up response times and maintaining continuity of care.

Patients, doctors and employers can learn more about reform efforts and share their personal experiences with prior authorization at FixPriorAuth.org.