The truth about Trump's vaccine order; half of U.S. internal medicine workforce was born abroad; Medicare moves to fast-track devices — Morning Medical Update Weekly Recap

Trump signs executive order narrowing childhood vaccine recommendations

The order recommends 11 diseases for all children and calls for splitting MMR into three shots that no manufacturer currently sells in the United States.

The order, signed Aug. 10, sorts childhood immunizations into three categories: recommended for all children, recommended for high-risk groups, and shared clinical decision-making. Eleven diseases stay on the all-children list, while hepatitis A, hepatitis B, RSV, rotavirus, meningococcal disease, influenza, COVID-19 and dengue move to the other two. The White House says that is down from the 18 diseases the CDC recommended in 2024. Nothing is withdrawn from the market.

The order also calls for MMR to be given as three single-disease shots. No manufacturer sells those in the United States; Merck stopped making them in 2008. Merck and GSK, the only two companies licensed to sell combined MMR here, told Reuters no published evidence supports splitting it, and Merck said FDA approval and manufacturing could take as many as 10 years. The order conditions the split on domestic availability and gives HHS 90 days to present plans.

An executive order recommends. It does not amend the CDC schedule, and states set school enrollment requirements. Section 4 directs the attorney general to challenge state laws on religious and medical exemptions and tells Justice, Education and HHS to ensure contractors and grantees comply. The White House said the Vaccines for Children program is unaffected. American Academy of Pediatrics President Andrew Racine, M.D., Ph.D., called the order "not only disheartening but dangerous," and the AMA, ACP, IDSA, the World Health Organization and the U.K. drug regulator objected or reaffirmed vaccine safety.

Related content: What primary care physicians need to know about Trump's vaccine order and AAFP President Sarah C. Nosal, M.D., on vaccine schedules, stocking costs and the back-to-school visit

Non-U.S.-born physicians make up 47.2% of the internal medicine workforce

A new study from the American Board of Internal Medicine finds they cared for more than 22 million Medicare patients in 2024.

Physicians born outside the United States account for 47.2% of the internal medicine workforce, according to an American Board of Internal Medicine (ABIM) study published in JAMA. In 2024 they cared for more than 22 million Medicare patients, whom researchers found were more likely to be dually eligible for Medicare and Medicaid, to live in high-poverty areas and to be Black or Latino. They made up at least 27% of every subspecialty examined. ABIM framed the findings against travel bans, higher H-1B visa fees and social media vetting of applicants, amid projected shortages across most internal medicine disciplines.

CMS details RAPID, its plan to cover new devices within 60 days of FDA authorization

The proposed notice would post a coverage decision the same day the FDA acts, and it pauses the TCET pathway to new candidates.

CMS published a notice with comment period Aug. 11 detailing how the Regulatory Alignment for Predictable and Immediate Device (RAPID) coverage pathway would work. CMS and the FDA announced it in April. A national coverage determination generally takes nine to 12 months; under RAPID, CMS would post a proposed determination the same day a participating device receives FDA authorization, with a final one roughly 60 days later for Class II devices and 90 days for Class III.

Participation is voluntary and limited to certain FDA-designated Breakthrough Devices whose manufacturers enter before their study begins and measure outcomes in Medicare patients. The notice also pauses the Transitional Coverage for Emerging Technologies pathway to new candidates and would prioritize RAPID decisions over others on the coverage wait list. CMS writes that beneficiaries are often older with multiple comorbidities and underrepresented in trials, so a device's benefits and harms for them may not be well understood when the FDA acts. Comments are due Oct. 13.