A series of recent changes could have significant implications for how Americans receive and pay for their shots.

Along with an influx of back-to-school illnesses, the coming school year may bring significant changes to how school-age kids are protected from many viruses. Both shifting political winds and public attitudes toward vaccines are poised to make it harder for many kids to show up to school healthy and ready to learn, public-health experts warn.

Downing did not respond to a voicemail left at his law office. HHS didn’t reply to a request to make him and Kennedy available for an interview and declined to answer detailed questions about its plans for the Vaccine Injury Compensation Program. In the past, an HHS spokesperson has said that Kennedy is “not anti-vaccine—he is pro-safety.”