The anti-vaccine movement is on the rise. The White House is at a loss over what to do about it.

This is the first story of a five-part series diving into the rise of the anti-vaccine political movement.

A Biden administration that vowed to restore Americans’ faith in public health has grown increasingly paralyzed over how to combat the resurgence in vaccine skepticism.

And internally, aides and advisers concede there is no comprehensive plan for countering a movement that’s steadily expanded its influence on the president’s watch.

The rising appeal of anti-vaccine activism has been underscored by Robert F. Kennedy Jr.’s insurgent presidential campaign and fueled by prominent factions of the GOP. The mainstreaming of a once-fringe movement has horrified federal health officials, who blame it for seeding dangerous conspiracy theories and bolstering a Covid-era backlash to the nation’s broader public health practices.

But as President Joe Biden ramps up a reelection campaign centered on his vision for a post-pandemic America, there’s little interest among his aides in courting a high-profile vaccine fight — and even less certainty of how to win.

“There’s a real challenge here,” said one senior official who’s worked on the Covid response and was granted anonymity to speak candidly. “But they keep just hoping it’ll go away.”

The White House’s reticence is compounded by legal and practical concerns that have cut off key avenues for repelling the anti-vaccine movement, according to interviews with eight current and former administration officials and others close to the process.

Biden officials have felt handcuffed for the past two years by a Republican lawsuit over the administration’s initial attempt to clamp down on anti-vaxxers, who alleged the White House violated the First Amendment in encouraging social media companies to crack down on anti-vaccine posts. That suit, they believe, has limited their ability to police disinformation online. In addition, Congress is clawing back Covid funds once earmarked for vaccine education and outreach. And Biden himself has opted to largely ignore Kennedy’s campaign, concluding there’s no political benefit to engaging with the increasingly longshot challenger or his conspiratorial views.

The approach has given conservative influencers and lawmakers who have embraced Kennedy and other vaccine skeptics more space to promote their views and tout themselves as free speech warriors doing battle against the Biden administration.

And the impact is clear: As another Covid vaccination campaign gets underway, fewer Americans than ever have kept up to date on their shots. Child vaccination rates against the flu are measurably lower than before the pandemic. Even standard childhood inoculations to prevent diseases like the measles are subject to deepening partisan divisions, with recent polling showing Republicans are now more than twice as likely to believe the shots should be optional than they did in 2019. Democrats, by contrast, remain overwhelmingly in favor of childhood vaccine requirements.

“We can see a long-term future where kids aren’t going to get vaccinated in schools, diseases that we once thought had ended will roar back and kids will get sick and die from 100 percent preventable conditions,” said Lawrence Gostin, a Georgetown University public health professor who has advised the White House. “This will cost lives in the long term."

Anti-vaccine sentiment isn’t new: In 2019, the U.S. reported the most measles cases in 27 years, an outbreak fueled by unvaccinated communities in parts of New York, California and Oregon. But its appeal was turbocharged by the pandemic, where political opposition to the Covid vaccines has melded in some corners with broader skepticism of immunizations as a whole.

In a statement, HHS spokesperson Ilse Zuniga said the administration knows “how important it is for people to have accurate, science-based information to protect themselves and their loved ones.”

“Science-based information has been and continues to be the Biden-Harris Administration’s North Star, and we will continue to work to share accurate information to protect the American public,” Zuniga said.

HHS also outlined a range of activities that it said is aimed at reinforcing that vaccines are safe and effective and promoting factual information, including monitoring social media for misinformation, working with local health officials to identify and correct misconceptions and publicizing its own set of online resources meant to address common questions and concerns.

Yet as Biden’s attention shifts to the 2024 race, administration officials and others close to the process say there is waning focus on the politically divisive public health issues that consumed his first two years.

The White House dissolved its Covid response team earlier this spring in favor of a new office focused on broader pandemic threats and is no longer deeply involved in combating the vaccine conspiracy theories flourishing daily online. When top officials mention the pandemic, it's now mainly to tout the nation’s emergence from its crisis phase. As for Biden, he openly defied his administration's Covid guidance earlier this month, declining to wear a mask in public on multiple occasions after being exposed to the virus.

Biden aides have instead delegated much of the responsibility for ongoing public health work back to HHS. But combating anti-vaccine sentiment on a large scale is not considered a top priority within the department, where Health Secretary Xavier Becerra has at times indicated he believes the administration has done all it can do.

“If you’re dying of Covid today, you didn’t take precautions,” Becerra said during a POLITICO health summit in June, taking an oblique shot at Florida Gov. Ron DeSantis and other prominent Republicans who have advanced anti-vaccine theories. “If you listened to someone who said you didn’t have to take that precaution, it’s not just your fault, it’s the fault of that leader who doesn’t give you the best information. If leaders choose not to take care of their people, that’s on them.”

The CDC, under new director Mandy Cohen, has sought to be more vocal in countering disinformation of late. After DeSantis' state surgeon general advised healthy residents not to get the most recent booster, Cohen called the decision "unfounded and, frankly, dangerous."

Yet the Biden health department no longer has the resources to run the sprawling network of community-level initiatives that proved effective in boosting trust in the vaccines early in the Covid response, as congressional support for Covid funding has dried up. Those still trying to make headway lamented the inability to keep up with fast-moving conspiracies spreading across social media, leaving them overwhelmed by the flood of myths and misconceptions that gain traction before the government can mount a response.

“This is asymmetrical warfare by definition,” said one former health official who worked on the administration’s public health messaging. “We will need the people who have the levers to change that equation to focus on this issue. Being right is wildly insufficient to win a public debate.”

The administration’s scaled-back approach to the anti-vaccine movement represents a notable shift from early in Biden’s presidency, when the success of his agenda hinged on vaccinating the nation against Covid.

Back then, senior aides leading the pandemic response saw combating misinformation as a critical priority. The White House spent months pressuring social media companies to stringently enforce rules against misinformation and flagging false claims from prominent vaccine skeptics — Kennedy among them. Its Covid team spent millions of dollars on public education programs. Surgeon General Vivek Murthy used his first official advisory to label health misinformation an “urgent threat."

The early focus extended to Biden himself, who declared in June 2021 that platforms like Facebook were "killing people" by allowing Covid conspiracies to spread. The denunciation was so harsh that even some aides leading the administration's misinformation battle thought it went too far, and Biden soon backtracked.

Still, health experts credited the aggressiveness of the campaign for helping get the vast majority of adults their first Covid shot in just seven months. But the virus’ resurgence later that summer caught the White House by surprise, scrambling its carefully planned vaccine messaging and allowing anti-vaxxers to elevate doubts about the shot’s effectiveness.

The administration’s disinformation fight never recovered.

The 2022 lawsuit led by Republican attorneys general that targeted the administration's work with social media companies dealt a major blow, quashing the prospect of a sustained effort to push back on anti-vaccine campaigns or target influential figures responsible for spreading conspiracy theories.

The suit set back the administration for months, according to three people familiar with the matter, as White House lawyers discouraged any initiatives that might add to the allegations.

Despite trying to not provoke a judicial rebuke, a federal judge in Louisiana nevertheless sided with the GOP plaintiffs in a July ruling. The judge banned a range of Biden officials and agencies from talking with social media companies, though the prohibition has since been paused while the administration seeks an intervention by the Supreme Court.

The administration also found itself mired for months in a standoff with congressional Republicans over more Covid funding. During that time, it pared back its ambitions and messaging, maintaining during the most recent vaccination campaign last fall that its role was primarily to ensure the vaccine was available for those who wanted it. Just 20 percent of adults got last year's shot, according to CDC data through May 11, down sharply from the 79 percent of adults who received their initial series of vaccinations in 2021.

The White House has since dropped its push for more Covid money in the face of solidified Republican opposition, instead agreeing earlier this year to let Congress claw back more than $27 billion of unspent funds in exchange for salvaging $5 billion earmarked for next-generation vaccines.

"It's become now a politically motivated movement," said Peter Hotez, a virologist at the Baylor College of Medicine who has written extensively about the anti-vaccine movement, arguing that vaccine skepticism has become more embedded in conservatives' worldview than ever before. "But I can't get any engagement out of anybody."

Hotez isn’t the only one arguing the administration could be doing more to combat the conspiracies and falsehoods, especially as they emerge more prominently during the current presidential cycle. DeSantis has made opposition to Covid precautions a central element of his campaign, most recently claiming without evidence the latest vaccine isn't safe or effective. And even Trump, who oversaw the record-fast development of the initial Covid vaccine, has acknowledged that fact is doing him no favors with GOP voters, vowing that he's "not going to talk about it one way or the other."

"I would like to see the surgeon general really take this on, and the HHS secretary as well," Gostin said. "They could both do worlds of good in approaching this from the health and medical point of view, not the political point of view."

Top health officials could double down on their work with local health departments to rebuild trust, experts said, eschewing the high-cost ad campaigns the government traditionally relies on in favor of sustained partnerships with community organizations that aren’t viewed as inherently political.

Health and disinformation experts have long called for establishing a cross-government task force focused on monitoring and organizing responses to misinformation. Others wondered why the White House has not kept up communications with the network of outside public health experts it cultivated during the height of the Covid response, and who could more freely dispute anti-vaccine arguments as they arise.

“Vaccines just saved this country’s ass, and there is no counter,” said another official who was involved with the Covid response. “What is it going to take to make the case that’s obvious?”

But as the administration pivots toward Biden’s reelection platform and leaves the Covid crisis further behind, there appears little concerted new energy going toward defending the vaccines behind its success.

In June, Hotez declined an invitation on X, the platform formerly known as Twitter, from podcaster Joe Rogan to debate Kennedy and his vaccine claims. It prompted a multi-day torrent of abuse from anti-vaxx accounts that amplified misinformation across the platform.

A range of colleagues, fellow health experts and even celebrities publicly joined the fray in Hotez’s defense. Others privately reached out to offer support. But, Hotez said, he never heard a word from anyone in the administration.

“It would’ve been nice if there was a call from the White House, Office of Science and Technology Policy, CDC or anybody to say hey Peter, we’ve got your back, and here’s what we’re doing about the [misinformation] issue,” he said. “Mark Hamill said I got your back. So at least I got Luke Skywalker. But nobody from the government.”