Advocates for pregnant people said they are alarmed by Robert F Kennedy Jr’s unprecedented and unilateral decision to remove Covid-19 booster shots from the recommended immunization schedule.

A vaccine’s inclusion on the schedule is important for patient access, because many private health insurance plans determine which vaccines to cover based on the schedule.

“Covid-19’s impact on pregnancy is deeply personal to me,” said Dr Amanda Williams, interim chief medical officer at March of Dimes, a non-profit focused on the health of mothers and babies, in a statement.

“During the height of the pandemic, I cared for a healthy patient who was 32 weeks pregnant and tragically died from Covid-19 despite state-of-the-art medical care. One of her last words was that she wished she had taken the vaccine.”

The Society for Maternal Fetal Medicine (SMFM), experts on high-risk pregnancy, said in a statement that it “strongly reaffirms its recommendation that pregnant patients receive the Covid-19 vaccine”, and that the vaccine is safe to receive at any time during pregnancy.

In a statement, the American College of Obstetricians and Gynecologists (ACOG) said it was “concerned about and extremely disappointed”.

“We also understand that despite the change in recommendations from [health and human services], the science has not changed,” said Dr Steven J Fleischman, ACOG president. “It is very clear that Covid-19 infection during pregnancy can be catastrophic and lead to major disability, and it can cause devastating consequences for families,” said Fleischman.

Kennedy made the announcement on Tuesday on social media, flanked by Trump administration appointees to the Food and Drug Administration (FDA) and the National Institutes of Health (NIH) – neither of whom are typically involved in such decisions.

Typically, changes to the recommended vaccine schedule are based on open public debate and the recommendation of an independent panel of experts at the Centers for Disease Control and Prevention’s advisory committee on immunization practices.

Kennedy’s announcement circumvented both the Centers for Disease Control and Prevention (CDC) and its advisory panel, and neither body was advised of the forthcoming decision, sources told STAT. The CDC is currently without a leader.

A directive making the change official, also reported by STAT, suggested that Kennedy reviewed the evidence with the FDA. That agency’s advisory committee, which is structured similarly to the CDC’s, was also bypassed.

Just a week earlier, the FDA’s head, Dr Marty Makary, published a similarly unprecedented article in the New England Journal of Medicine that described pregnancy and recent pregnancy as on a list of “underlying medical conditions that can increase a person’s risk of severe Covid-19”.

As of Tuesday, the CDC’s website continued to state that those who are pregnant are at increased risk of severe illness if they contract Covid-19, including heightened risk of hospitalization and the need for intensive care. Further, evidence shows that mothers who are vaccinated pass protective immunity to infants, without the many risks that come alongside Covid-19 infection during pregnancy.

Infants younger than six months old are at the highest risk of severe disease among children, with the risk to children younger than four years old on par with that of 50-to-64-year-old adults, according to the Journal article.

“Kennedy’s unilateral decision to change the CDC’s recommended immunization schedule for Covid-19 vaccines demonstrates once again why he is completely unqualified to be the HHS secretary,” said Dr Robert Steinbrook, research director at consumer rights group Public Citizen, said in a statement.

“In Congressional testimony on May 14, Kennedy said, ‘I don’t think people should be taking medical advice from me.’ Yet two weeks later he is making arbitrary public health decisions, defying norms, and with no accountability.”

Despite the known risks of contracting Covid-19 while pregnant, public health authorities have struggled to get pregnant people vaccinated. CDC data shows only about 14% of pregnant people received the most recently updated Covid-19 vaccine.

Kennedy’s decision to unilaterally change the vaccine recommendation comes as some of his supporters, particularly anti-vaccine advocates, continue to call for Covid-19 vaccines to be completely removed from the market.