President Donald Trump has threatened to invoke the Insurrection Act to send federal military forces to Minneapolis in response to protests against Immigration and Customs Enforcement actions in the city. We’ll explain what the law says about the president’s authority to do so.
Trump cited the act in a Jan. 15 social media post, eight days after an ICE officer fatally shot Renee Nicole Good during a protest confrontation. The shooting sparked more protests in Minneapolis and the Trump administration’s deployment of hundreds more immigration officers to join 2,000 Department of Homeland Security agents sent to the Minneapolis-St. Paul area as of early this month, according to DHS. The department has called it “Operation Metro Surge.”
“If the corrupt politicians of Minnesota don’t obey the law and stop the professional agitators and insurrectionists from attacking the Patriots of I.C.E., who are only trying to do their job, I will institute the INSURRECTION ACT,” Trump wrote on Truth Social.
On Jan. 12, Minnesota and the Twin Cities filed a lawsuit against DHS, asking the courts to end the surge of immigration officers, calling it “unconstitutional and unlawful.” The suit says that the “agents’ reckless tactics endanger the public safety, health, and welfare of all Minnesotans.”
Minneapolis Mayor Jacob Frey said on Jan. 15 that the city’s police force was “approximately 600,” while there were “approximately 3,000 ICE agents in the area.” The latter figure, which includes other DHS officers, not solely ICE, amounts to “nearly one agent for every 1,000 of the Twin Cities’ 3.2 million residents,” the Minnesota Star Tribune reported.
Last fall, Trump similarly said he could invoke the Insurrection Act to override the objections of the Illinois and Oregon governors to Trump’s National Guard troop deployments in those states. (Those deployments have been blocked by the courts while litigation proceeds.) Here, we’ll repeat much of what we wrote about the law in an Oct. 17 article about the issue then.
Under the Posse Comitatus Act of 1878, federal military forces can’t perform civilian law enforcement tasks. However, the Insurrection Act provides an exception to this.
Under the Insurrection Act, which dates back to 1792, a state legislature or governor could request that the president send federal military forces to suppress an insurrection, or the president could invoke the act himself “[w]henever the President considers that unlawful obstructions, combinations, or assemblages, or rebellion against the authority of the United States, make it impracticable to enforce the laws of the United States in any State by the ordinary course of judicial proceedings,” the statute says.
The president also can invoke the act to suppress “any insurrection, domestic violence, unlawful combination, or conspiracy” in two scenarios: if it “hinders the execution” of state and federal laws and deprives people’s constitutional rights or protections and state authorities “are unable, fail, or refuse to protect that right, privilege, or immunity”; or if the insurrection/violence “opposes or obstructs the execution of the laws of the United States or impedes the course of justice under those laws.”
Joseph Nunn, a counsel in the Brennan Center for Justice’s liberty and national security program, wrote in an explainer on the Insurrection Act that, in theory, it “should be used only in a crisis that is truly beyond the capacity of civilian authorities to manage,” but the statute “fails to adequately define or limit when it may be used.” Nunn, who has written about limiting the use of the military for law enforcement purposes, said the statute is “dangerously overbroad and ripe for abuse.”
In his Jan. 15 social media post, Trump said that “many” presidents have used the act, and a week prior, he said that “48 percent of the presidents have used it.”
Eighteen of 45 presidents, or 40%, have invoked the act for crises such as rebellions, labor disputes and enforcing civil rights federal court orders. Most of these crises occurred prior to 1900. The most recent use of the act was in 1992, when the California governor asked President George H.W. Bush to do so in order to send federal troops to assist with civil unrest that erupted in Los Angeles following the acquittal of white police officers charged for beating Rodney King, a Black motorist.
The Brennan Center for Justice has a list of all times the Insurrection Act has been used for 30 crises, dating back to 1794 under President George Washington. Troops have not always been deployed. “Sometimes the mere threat of military intervention has been enough to resolve a crisis,” the Brennan Center said.
William Banks, a professor at Syracuse University College of Law, and Mark P. Nevitt, an associate professor at Emory University School of Law, wrote in a piece for Just Security that “the last time the National Guard was federalized over a governor’s objection was in 1965, when President Lyndon B. Johnson deployed the Guard to Selma, Alabama to protect civil rights demonstrators.” Johnson invoked the Insurrection Act.
In 1989, Bush invoked the act to send troops to the Virgin Islands to quell lawlessness following the destruction caused by Hurricane Hugo. The Brennan Center says there’s a dispute over whether the territorial governor of the islands requested the federal deployment.
There’s “little case law” on the act, Nevitt told us last fall. Nevitt said in an email that the “leading case is from the War of 1812 (Martin v. Mott), where the Supreme Court suggested that the president has broad discretion in interpreting the act’s statutory language.”
Nevitt said there’s no judicial review in the statute and “courts have been reluctant to second-guess presidential authority in using the military,” but the courts are addressing such authority in the cases in California, Oregon and Illinois involving federalization of the National Guard over governors’ objections. “A court challenge is likely,” if Trump uses the Insurrection Act, “but it remains to be seen whether a federal judge will find the case justiciable,” Nevitt said.
Nunn wrote that the high court “has suggested that courts may step in if the president acts in bad faith, exceeds ‘a permitted range of honest judgment,’ makes an obvious mistake, or acts in a way manifestly unauthorized by law” and “that courts may still review the lawfulness of the military’s actions once deployed.”
In an Oct. 12 ABC News interview, former New Jersey Gov. Chris Christie, who is also a former U.S. attorney, said that if Trump invokes the Insurrection Act, “you can’t stop him if you’re the governor.” But the governor “could always bring a court action and then the courts could decide whether the facts are there to support his [Trump’s] invocation of the Insurrection Act,” Christie said.
In sweeping changes to the childhood vaccine schedule, the Centers for Disease Control and Prevention no longer recommends universal vaccination against six diseases. In justifying the move, health officials made misleading claims about vaccine safety while downplaying or omitting benefits.
In signing a Jan. 5 memo, CDC Acting Director Jim O’Neill eliminated routine childhood recommendations for vaccines against four diseases: rotavirus, hepatitis A, meningococcal disease and influenza. We’ll assess the rationale for the change for those vaccines. Previously, O’Neill accepted proposals to end the universal recommendation for hepatitis B and COVID-19 vaccination. We previously addressed misleading and unfounded claims about those shots.
The CDC now recommends all children receive vaccines targeting 11 diseases, down from 17 just a few months ago.
The latest changes came after President Donald Trump asked O’Neill and Health and Human Services Secretary Robert F. Kennedy Jr. on Dec. 5 to review vaccine schedules of “peer, developed countries” and consider “aligning” the U.S. schedule with them.
“After an exhaustive review of the evidence, we are aligning the U.S. childhood vaccine schedule with international consensus while strengthening transparency and informed consent,” Kennedy said in a Jan. 5 press release announcing the changes.
However, as we have written previously, vaccine schedules among high-income nations are quite similar. In recommending vaccination against just 11 diseases, the U.S. childhood schedule now universally targets fewer diseases than nearly all other “peer nations,” as defined in a table cited in the HHS memo, with the sole exception of Denmark.
The Jan. 5 memo bypassed the CDC’s Advisory Committee on Immunization Practices. This group for many years followed a formal, evidence-based process — occurring over months and involving experts with multiple specialties — to assess potential changes to the vaccine schedule. Findings were presented to experts and the public in advance of making changes.
To justify the recent changes, HHS officials instead cited a 33-page assessment prepared by two political appointees: Dr. Tracy Beth Høeg, a doctor specializing in sports medicine who is acting director of the Food and Drug Administration’s drugs division; and Martin Kulldorff, a biostatistician and epidemiologist whose appointment to an HHS leadership role was announced last month. Kulldorff was formerly the chair of ACIP after Kennedy reconstituted the committee in June.
O’Neill was chosen for his CDC role after the prior director was fired following clashes with Kennedy over the vaccine schedule.
“You basically have a group of federal appointees going behind closed doors and making recommendations about a vaccine — without any input from the public, without any input from experts in the field — and just making up their own schedule,” Dr. Paul Offit, a pediatrician and vaccine expert at Children’s Hospital of Philadelphia, told us.
The six vaccines dropped from universal recommendations are now recommended under shared clinical decision-making, which means that people may still get these vaccines after a discussion with a health care provider. (Surveys done by the University of Pennsylvania’s Annenberg Public Policy Center, our parent organization, found some misunderstanding of the term among the public.) This designation was previously used for uncommon cases where a vaccine was “not recommended for everyone in a particular age group or everyone in an identifiable risk group,” according to the CDC. There remain stronger recommendations that children with certain risk factors get hepatitis A, hepatitis B and meningococcal disease vaccines.
For the time being, the changes largely do not alter whether insurers cover vaccination, and the affected vaccines should be available at no cost, according to a review from KFF, a nonpartisan health policy organization.
We asked HHS a variety of questions, including why the normal process for changing the vaccine schedule was not followed. Press Secretary Emily G. Hilliard described Trump’s memo asking for a review of vaccination recommendations. “The updated CDC childhood immunization schedule reflects the results of that thorough review and preserves access and insurance coverage to all vaccines currently available to American children and adolescents,” she said.
Rotavirus is a gastrointestinal infection that causes diarrhea, vomiting and fever and can lead to dangerous dehydration. According to the analysis in the HHS assessment, 17 out of 20 peer nations routinely recommend vaccination against the disease.
In justifying no longer recommending rotavirus vaccines routinely, HHS officials deemphasized the significant number of hospitalizations the vaccines prevent while also minimizing the number of children the virus previously killed.
“In the U.S., it can cause hospitalization for gastroenteritis, but the virus poses almost no risk of either mortality or chronic morbidity,” the assessment and memo both said.
Offit, the vaccine expert from CHOP, told us that the suffering caused by rotavirus was significant. Offit co-invented one of the two available rotavirus vaccines.
Prior to the 2006 CDC recommendation to vaccinate all babies against the disease using an oral vaccine beginning at 2 months of age, around 55,000 to 70,000 children were hospitalized each year due to rotavirus, according to a 2018 review by CDC researchers.
“It’s very hard for parents to rehydrate their child orally when the child is constantly vomiting,” Offit told us, recalling that before rotavirus vaccines were available, his hospital during his pediatric residency saw around 400 inpatients with severe dehydration from rotavirus each year. He also saw a previously healthy nine-month-old girl die of the disease. Today, he said, “most pediatric residents at our hospital have never seen an inpatient with rotavirus dehydration.”
Vaccination not only lowers the risk of hospitalization in vaccinated people, the CDC review noted, but it also lowers transmission and, therefore, the risk of hospitalization in those who are not vaccinated.
The assessment went on to give low estimates of rotavirus deaths in the pre-vaccine era. “Data from CDC indicate that among all U.S. children <15 years of age, there were an average of 3.3 deaths per year with the rotavirus diagnostic code listed on the death certificate between 1999 and 2005,” they wrote, citing a CDC database.
The 2018 review by CDC researchers estimated 20 to 60 deaths from rotavirus annually before the vaccines were recommended.
The assessment’s approach of estimating deaths relies on the deaths being recorded using a specific code, Offit said. “That’s a fairly blunt tool and no doubt is an underestimate,” he said. An HHS spokesperson did not answer a question on why the assessment estimated rotavirus deaths in this way.
Since 2005, the CDC has universally recommended a vaccine, MenACWY, at age 11 or 12 that targets four subtypes of meningococcal bacteria to protect against meningitis and sepsis. These infections are rare but are very serious and can be fatal. In 2010, the agency added a universal recommendation for a booster dose at age 16. (A separate vaccine exists for meningococcal type B bacteria, but it has not been recommended for all children in the U.S.)
Under the new changes, the MenACWY vaccine is now recommended for all kids only under shared clinical decision-making. For high-risk groups, including those with certain medical conditions, college freshmen living in residential housing or those traveling to certain countries, the vaccine remains fully recommended.
The cited rationale for removing the universal recommendation was primarily that the disease incidence is low, currently around 0.12 cases per 100,000 people. The memo and assessment particularly cited World Health Organization guidelines, which advise widespread vaccination when the incidence is 2 cases per 100,000 or higher. The HHS documents also pointed to a country comparison to suggest that universal vaccination programs have not driven down disease rates and noted that not all peer countries recommend meningococcal vaccination for all children.
“The incidence of meningococcal disease has declined during the past decades, both in countries with and without the routine vaccine recommendations for children, and the magnitude of the decline appears to be independent of vaccination policy,” the memo said.
While there isn’t universal agreement on routine meningococcal vaccination, most high-income countries do recommend the shots — even though their disease incidence is also low. According to the health officials’ own count, 15 out of 20 peer nations have a recommendation for all children, while five have a risk-based recommendation. Some nations, such as Germany, Switzerland and the U.K., now routinely recommend two different meningococcal vaccines during childhood.
Meningococcal disease is indeed rare in the U.S. But several experts told us this is not a reason to stop vaccinating. They also disputed the suggestion that vaccination hasn’t helped to lower disease incidence.
“Every parent should want to prevent this disease in their children,” Dr. David S. Stephens, an expert on bacterial meningitis at Emory University, told us, noting the seriousness of meningococcal disease.
Even with antibiotics and proper medical care, around 15% of patients die and as many as 20% are left with after-effects of the illness, including amputations, neurologic disabilities and hearing loss, according to a 2020 summary report of ACIP’s recommendations for meningococcal vaccines.
“[L]ow incidence in the context of a vaccination program is what we want,” Stephens said in an email. “Even though polio is very low in the US we still recommend routine vaccination.”
Stephens, who is a member of the expert panels advising the WHO and the CDC on meningococcal vaccination, noted that the disease is more common among adolescents and young adults than in the general population and that the incidence can fluctuate. CDC data show that in recent years, infections have surged, with 2024 posting 503 confirmed or probable cases of meningococcal disease — the highest number since 2013. Antibiotic resistance is also increasingly a problem.
Stephens said that the vaccination program has helped reduce disease incidence and that the MenACWY vaccines in particular provide “significant ‘herd’ protection to the unvaccinated.” He said the cited country comparison “has no bearing on the question of meningococcal vaccine effectiveness.”
“It is well known that the disease incidence began to decline before the introduction of the meningococcal vaccine, however, there is evidence that the decline was faster after the introduction of the vaccines,” Dr. Jaime Fergie, an infectious diseases specialist with Driscoll Children’s Hospital in Texas, told us, citing a 2020 paper.
He added that a 2024 modeling study estimated that through 2021, vaccination in the U.S. prevented 500 cases of invasive meningococcal diseases and 54 deaths of people 11 to 23 years of age. Without vaccination, invasive meningococcal disease incidence “would have been at least 59% higher than reported,” the study concluded.
The HHS memo also misleadingly noted that the current meningococcal vaccines “were not evaluated in large-scale double-blind placebo-controlled randomized trials before FDA approval.”
While true, Caroline Trotter, infectious disease epidemiologist at the University of Cambridge who specializes in vaccine-preventable bacterial meningitis and also advises the WHO on meningococcal vaccination, told us this is “because such studies were not ethical (because of the existence of already licensed polysaccharide vaccines for MenACWY) or feasible (given the large numbers that would have to be recruited).”
When vaccines that protect against a disease already exist, it’s unethical to test newer versions against a saline placebo, since the control group would have to forgo any protection.
“There is compelling evidence from a range of different settings, including the UK, that meningococcal vaccines are safe and effective,” she added.
“The change in schedule will increase vaccine disparities, we are also likely to see the return of this disease in more adolescents, young adults, and others over the next decade,” Stephens said.
The CDC first recommended annual flu shots for all children 6 months and older in 2008, when it expanded the recommendation to include school-aged children 5 to 18 years old. The agency had already recommended the shot for children under the age of 2 in 2004 and children below the age of 5 in 2006.
According to the published ACIP recommendation, the decision was based on “accumulated evidence” of the vaccine’s safety and effectiveness in school-aged kids, “increased evidence” of flu’s “substantial adverse impacts among school-aged children and their contacts,” and “an expectation” that the simpler recommendation would boost vaccine uptake among kids who were at higher risk of severe disease or were in contact with such individuals. About half of school-aged children were in that category and were already recommended to get vaccinated.
Children below the age of 5 and those with certain chronic conditions are at higher risk for flu complications such as pneumonia, according to the agency, but healthy older children can also get seriously ill.
Death is rare, but does occur. Since the 2004-2005 flu season, reported pediatric flu deaths, which are likely an undercount of the true number of deaths, have averaged 137 a year when excluding the 2020-2021 season during the COVID-19 pandemic. Last year’s flu season was rough, however, and 289 children died — the most since the agency began tracking deaths over two decades ago. More than 40% of those children did not have underlying medical conditions, and nearly 90% had not been fully vaccinated. This year is also shaping up to be an unusually bad flu season.
In explaining why they no longer recommended universal flu vaccination for kids, health officials pointed to the lack of randomized controlled trial data showing a hospitalization or death benefit of flu vaccination in children.
“The trials could not evaluate differences in hospitalizations or mortality, as there were none or few in either group, so they provide no evidence that the vaccines reduce hospitalization or deaths,” the memo said, citing a 2018 Cochrane review, which the health officials called the “most comprehensive review.”
The memo also dismissed observational studies, calling one particular type of study — the test-negative case-control study — “a notoriously biased study design with highly implausible results,” and the memo referred to a “scarcity of reliable safety data.”
In an interview with CBS News on Jan. 7, HHS Secretary Kennedy also cited the Cochrane review when he said it may be “better” if fewer kids receive the flu vaccine as a result of the new policy. “They found that there is no evidence that the flu vaccine prevents serious disease or that it prevents hospitalizations or death in children,” he said, referring to the Cochrane authors. “There’s no scientific evidence. And what we tried to do is to follow the science.”
Experts, however, say this is misleading.
The Cochrane review, which focused almost exclusively on randomized controlled trials, did not identify hospitalization or death benefits of flu vaccination, but it also did not include any trials with data on those outcomes. It did, notably, find evidence that flu shots worked to reduce influenza in children.
Dr. Mark Loeb, an infectious diseases specialist at McMaster University in Canada who has studied flu vaccines, told us that one of the limitations of randomized controlled trials is that they are not practical to use to evaluate outcomes that are rare, such as hospitalization or death in this case. “Because the outcomes are very rare” in healthy kids, he said of influenza, “you’d need millions of people in a randomized controlled trial.”
This does not mean that flu vaccines don’t work to prevent severe outcomes, but that randomized trials are not an ideal way to measure those potential benefits. Loeb said that he primarily conducts randomized trials — and thinks such trials should be done whenever possible — but not in this case.
“The HHS Decision Memo ignores the fact that clinical trials are not powered to detect rare outcomes such as hospitalization and death,” Dr. Edward Belongia, a global expert on flu vaccine effectiveness who retired from the Marshfield Clinic Research Institute in Wisconsin last year, told us in an email. “Post-licensure observational studies are needed to provide valid estimates of influenza vaccine protection in the real world, including protection against serious outcomes.”
Contrary to HHS’ claim that test-negative case-control studies are “notoriously biased,” Loeb said they were “one of the most rigorous forms of observational studies.”
Belongia said the test-negative design “is the current gold standard” for observational studies of influenza vaccine effectiveness, noting that it “has been directly compared with clinical trial data and shown to generate comparable results.”
In such studies, patients needing medical care for respiratory illness are enrolled in the study and then tested for influenza, Belongia explained. Vaccine effectiveness can then be estimated based on the number of “case” patients who test positive for flu compared with the number of control patients who test negative. “An important advantage of this design is that it inherently controls for bias due to differences in health care seeking behavior,” he said.
“Like the Cochrane review authors, the HHS Decision Memo ignores a large body of evidence that influenza vaccines are effective in children, including substantial protection against severe illness,” Belongia added, citing multiple papers.
A review published in the New England Journal of Medicine in October, for example, which looked at the evidence since ACIP’s last review of the subject a few years ago, identified a vaccine effectiveness of 67% in preventing pediatric hospitalization. Another study, assessing vaccine effectiveness during the 2015-2016 season, found vaccination was 56% effective against hospitalization in children.
Last year, Loeb also published a review of test-negative studies on flu vaccination, which concluded that “[s]easonal influenza vaccination moderately reduces severe influenza-related outcomes, particularly in children.”
As for safety, Loeb said that unless a person has had a severe allergic reaction to a previous flu shot, the vaccine is a “very safe” vaccine. “There is a large amount of safety data,” he said, and “very good evidence” that the benefits “greatly outweigh” the risks.
The hepatitis A virus infects the liver, in rare cases causing liver failure and death. HHS officials emphasized the low incidence and death rate from hepatitis A, while making misleading claims about the safety of hepatitis A vaccines.
Hepatitis A vaccination was first recommended for some children in 1996 and eventually universally recommended in 2006 starting at 12 months of age. Now, the vaccines are recommended for all kids only after discussion with a doctor, although they are still fully recommended for kids traveling to countries with high or intermediate levels of hepatitis A, which is spread in feces.
“Given the low U.S. incidence and mortality, and the lack of randomized placebo-controlled safety data, the benefit-risk ratio is at best very low for most children,” the assessment and memo both said. An HHS spokesperson did not answer a question about what harms from hepatitis A vaccination the documents were referring to.
Dr. Noele Nelson, a physician and epidemiologist at Cornell University, told us the new recommendations are “missing the big picture” of why hepatitis A vaccination was recommended for children in the first place. Nelson was previously in leadership roles at the CDC, including as a branch chief in the viral hepatitis division.
Young children are not at high risk of death or severe illness from hepatitis A and generally have no symptoms when infected, but they do transmit the virus, Nelson explained. Those at higher risk of severe disease include adults over the age of 40 and people with certain health conditions.
Children can shed the hepatitis A virus in their stool for months, and it can remain infectious on surfaces for months, according to a 2020 report co-authored by Nelson, which summarized a review of hepatitis A vaccination by ACIP. Children “can transmit in daycare centers, they can transmit in schools, they can transmit to caretakers,” Nelson told us. It “used to be children in diapers were the ones who were spreading it to susceptible adults,” she said. If vaccination rates go down substantially, “it’s very conceivable that you would start to see that again.”
Vaccinating kids against hepatitis A both prevents them from spreading the virus and protects them into adulthood, as the vaccine “has long-term effectiveness and likely confers lifetime immunity, really one of the marvels of vaccinology,” Nelson added.
The HHS assessment and memo also cast doubt on the safety of the hepatitis A vaccines, misleadingly claiming that “without a proper placebo-controlled randomized trial, reliable safety data is limited.”
As we’ve written in the past, this is an anti-vaccine trope that relies on a very narrow definition of a proper clinical trial and dismisses other types of studies that can be used to help establish vaccine safety.
The clinical trials testing the hepatitis A vaccines “were incredibly successful, with no severe adverse events noted,” Nelson said, adding that in her judgment they were “done properly.” Furthermore, she said, data on vaccine safety are regularly reviewed, including by ACIP for the 2020 review and update she participated in. “Again, there were no concerning or unexpected safety findings,” she said.
One randomized, placebo-controlled trial that the assessment did not consider “proper” in their assessment compared a hepatitis A vaccine to a vaccine diluent. This contained an aluminum adjuvant, used in hepatitis A vaccines to stimulate a better immune response, as well as a preservative formerly used in the vaccines. These vaccine ingredients have a proven safety record. A second trial used a hepatitis B vaccine as a control.
Vaccinologist John Grabenstein, formerly head of medical affairs at Merck, told Science that it is common to use such controls in vaccine clinical trials. Merck’s hepatitis A vaccine, for example, he said, was compared to the diluent so that the trial could remain blinded and people would be less likely to tell whether they had been given the vaccine.
The other vaccine, made by GSK, was compared with a hepatitis B vaccine in a clinical trial in Thailand because the researchers wanted to ensure all children got some benefit from enrolling, the Science article explained. Using the hepatitis B vaccine in the control group also helped the trial remain blinded, Nelson told us.
She said that regardless of which groups they were assigned to, the participants in the trials only experienced “common, expected reactions,” such as pain at the injection site and fever. She added it was difficult to see, “even if those studies were done differently, how that would have changed the findings.”
Offering universal hepatitis A vaccination for children is a relatively uncommon practice among high-income nations. Among the 20 peer nations in the assessment, just one — Greece — had a universal hepatitis A vaccine recommendation.
However, stopping hepatitis A vaccination in childhood has risks, Nelson said. There are currently adults who are too old to have been routinely vaccinated as children but who grew up at a time when childhood infection was becoming less common. As a result, many don’t have immunity from past infection. Because infection is riskier when people are older, this group of people is now at risk of severe disease.
The problem with “not vaccinating children, when you still have circulating virus in the population and continued threats from food and threats from travel, is that you can increase the number of children with hepatitis A, which can then increase the number of adults,” Nelson said. Then “you really start to see this increase in morbidity and mortality, hospitalizations, and cost and burden on health care.”
In addition, children who never get vaccinated and who avoid infection will be susceptible to infection and severe disease as they age.
Low rates of hepatitis are “not a reason to stop vaccinating,” Nelson said, “because as soon as you let your guard down, or let that susceptible population increase, then you open yourself up to disease.”
President Donald Trump said one reason that the U.S. will “run” Venezuela and “indefinitely” control its oil sales is because “years ago” Venezuela “took our oil away from us” and “stole our assets.” That’s an oversimplification of what happened when Venezuela assumed greater control of its energy sector.
In 2007, under then President Hugo Chávez, Venezuela continued the nationalization of its oil industry that began in 1976. The Chavez administration required the foreign oil companies still operating in the country to enter into new contracts giving Venezuela’s state-owned oil and gas company majority control of their oil projects.
The companies that did not agree to those conditions were expropriated, meaning their oil-related assets were seized by the Venezuelan government.
“They did change the terms of the deals that they had with the companies that were operating in Venezuela,” Roxanna Vigil, an international affairs fellow at the Council on Foreign Relations, told us in an interview. But Vigil said the assets belonged to the private companies, not the U.S. government.
Furthermore, the oil in the ground always belonged to Venezuela.
Samantha Gross, director of the energy security and climate initiative at the Brookings Institution, told CBS News that “the oil itself was never ‘our oil,'” as Trump said. Gross clarified that Venezuela has ownership of its oil reserves, which are the largest of any nation.
Two U.S.-based oil companies, Exxon Mobil and ConocoPhillips, did not agree to Chávez’s conditions and left the country. Chevron, another American company, did agree to the terms and continues to produce oil in the country.
But in Trump’s eyes, Venezuela “stole” from the U.S.
“We built [the] Venezuela oil industry with American talent, drive and skill, and the socialist regime stole it from us,” Trump said in a Jan. 3 press conference, in which he talked about the U.S. military operation that led to the capture of Venezuelan President Nicolás Maduro and his wife, Cilia Flores.
The following day, while on Air Force One, Trump told reporters, “It was the greatest theft in the history of America. Nobody has ever stolen our property like they have. They took our oil away from us.”
When we inquired about the president’s claims, a White House official pointed to the nationalization of Venezuela’s oil industry to support what Trump said.
In 1975, Carlos Andrés Pérez, then the president of Venezuela, signed a bill nationalizing the country’s oil industry and creating a state-run company, Petróleos de Venezuela S.A., or PDVSA, to completely control oil production in the country.
A New York Times article from that year said that the new law ended “more than half a century of dominance by foreign oil companies” in Venezuela, including U.S. companies such as Exxon, Mobil and Gulf Oil, which previously had been granted concessions contracts to extract Venezuela’s oil in exchange for at least half of the profits that companies made from oil sales.
Before nationalization, “the contracts that these companies had,” which were set to expire in 1983, “basically authorized them to produce oil and pay royalties and taxes to the Venezuelan government,” Francisco Monaldi, director of the Latin America Energy Program at Rice University, told NPR in a podcast interview published on Jan. 8.
In 1977, a year after nationalization went into effect, the Times reported that about 20 foreign oil companies affected by the takeover ended up being paid about $1 billion in compensation from the Venezuelan government, and some negotiated contracts to continue providing marketing and technological support in the country.
Monaldi said that the arrangement “was not controversial at all with the oil companies.”
In the 1990s, Venezuela implemented a policy that allowed foreign oil companies back into the country specifically for the purpose of increasing oil production, particularly in the Orinoco Belt region, where most of the country’s oil reserves are located. However, things went differently in 2007, when the Chávez regime enacted another nationalization plan that saw PDVSA take a minimum 60% stake in foreign oil projects in the Orinoco Belt.
At least four major international oil companies, including Chevron in the U.S., agreed to the terms of new contracts that allowed them to continue their oil operations there. “And in fact, Chevron has been able to make money after they were partially expropriated,” Monaldi said on the podcast.
Two other U.S. companies, Exxon Mobil and ConocoPhillips, did not agree to Chávez’s demands, and withdrew from the country, abandoning their oil projects and equipment. Petro-Canada, which had partnered with Exxon Mobil on an oil project in the country, also opted to pull out of Venezuela.
At the time, news outlets quoted then U.S. State Department spokesman Tom Casey as saying, “The government of Venezuela, like any other government, has the right to make these kinds of decisions to change ownership rules.” But he said he hoped to “see them meet their international commitments in terms of providing fair and just compensation” to the companies.
Exxon Mobil and ConocoPhillips ended up having to go through international arbitration to get compensated by Venezuela for the expropriation of their oil assets.
It wasn’t until 2012 that the International Chamber of Commerce said that Exxon Mobil should receive $908 million in compensation and then awarded $2 billion for ConocoPhillips in 2018. Meanwhile, the World Bank’s International Centre for Settlement of Investment Disputes ordered Venezuela to pay $1.6 billion to Exxon Mobil in 2014 and $8.7 billion to ConocoPhillips in 2019.
The companies say they have been paid only a fraction of the billions of dollars they’re owed.
Exxon Mobil’s past experience with Venezuela is one of the reasons the company says it is taking a wait-and-see approach to reinvesting in oil ventures in the country – even though Trump has said that U.S. oil companies will now “spend billions of dollars” to fix the country’s “badly broken infrastructure.”
To reenter Venezuela a “third time would require some pretty significant changes from what we’ve historically seen here and what is currently the state,” Darren Woods, Exxon Mobil’s chairman and CEO, said at a Jan. 9 meeting of oil company executives at the White House. “If we look at the legal and commercial constructs and frameworks in place today in Venezuela, today it’s uninvestable.”
Energy experts also have said that improvements would be necessary to secure future investments.
“Foreign companies are looking for an improvement in governance, the restoration of the rule of law, and an easing of US oil sanctions,” including ones levied against Venezuela during the first Trump administration, Luisa Palacios, an adjunct senior research scholar at the Center on Global Energy Policy, said in a Jan. 4 blog post.
She said if the Venezuelan government can “commit to these reforms in a serious way,” leading the U.S. to remove sanctions, it’s “plausible” that in two years, oil production in Venezuela could increase by as much as 1 million barrels per day. As of November, production in the country was about 860,000 barrels per day, according to an International Energy Administration oil market report.
Jorge León, senior vice president and head of geopolitical analysis for Rystad Energy, told ABC News in Australia that it would take 15 years and investments of more than $180 billion for Venezuela to return to its pre-Chavez production rate of 3 million barrels per day.
In the meantime, Secretary of State Marco Rubio said that the U.S. will take from Venezuela “between 30 and 50 million barrels of oil” that have already been produced and packaged, and “sell it in the marketplace.” Purchased at market value, the oil could raise between $1.65 billion and $2.75 billion in revenue for the U.S. government, according to CNN.
Energy Secretary Chris Wright told CNBC that any oil revenue would first be used to help “stabilize the economy in Venezuela.” He said that repaying the U.S. oil companies that Venezuela still owes money is a “longer term issue.”
The Trump administration and some Democrats have drawn divergent conclusions from bystander video of the fatal shooting of a woman in Minnesota by an Immigration and Customs Enforcement agent. How can one side say the agent was “recklessly using power” and the other determine he “fired defensive shots”? Experts told us it’s common for people to view the same video differently, and that the early evidence isn’t enough to reach definitive conclusions.
Shortly after the Jan. 7 incident, in which 37-year-old Renee Nicole Good was killed by the agent in Minneapolis, President Donald Trump posted on Truth Social a video clip of the shooting, captured from a distance, and said that the woman “violently, willfully, and viciously ran over the ICE Officer, who seems to have shot her in self defense.” Additional bystander video, captured closer to the shooting, showed the agent wasn’t run over but left unclear whether the vehicle struck him. Republicans and Democrats have still disagreed on what the early video evidence depicted.
Department of Homeland Security Secretary Kristi Noem said in a Jan. 7 press conference, “This appears as an attempt to kill or to cause bodily harm to agents, an act of domestic terrorism,” determining that the ICE officer “fired defensive shots” because he was “fearing for his life.” The next day, Vice President JD Vance echoed that assessment, saying, “She was trying to ram this guy with his — with her car.”
Democratic leaders in Minnesota have disputed that. Minneapolis Mayor Jacob Frey said on Jan. 7, “So they are already trying to spin this as an action of self-defense. Having seen the video … myself, I want to tell everybody directly. That is bullshit. This was an agent recklessly using power that resulted in somebody dying, getting killed.” In a press conference that day, Gov. Tim Walz referred to “a very difficult video to watch,” saying it was “beyond me” that Noem “has already determined who this person [Good] was, what their motive was.” He criticized the large deployment of federal agents in Minneapolis and said that Good was killed “for no reason whatsoever.”
New York City Mayor Zohran Mamdani told CNN on Jan. 9 that Good had been “murdered.” He said, “That was the conclusion I came to just in watching that video. And I think that many Americans came to that same conclusion.”
“It is not only very common for different people to watch the same video and come to different conclusions, it is almost inevitable,” Seth W. Stoughton, a law professor and faculty director of the Excellence in Policing & Public Safety Program at the University of South Carolina, told us in an email. “First, people can disagree about the underlying facts of what happened. For example, viewers may disagree about whether the agent was standing in front of a car or next to the car at a specific time. Second, even when people agree about the facts, they can disagree about the conclusions that can be drawn from those facts. For example, even if everyone agrees that the agent was next to the car, they might disagree about whether he was in danger of being struck by the car or whether the use of deadly force was appropriate.”
Ed Obayashi, an expert on use-of-force cases, and deputy sheriff and policy adviser for the Modoc County Sheriff’s Office in California, told us that “it is basic fundamental human nature” for people to take sides when viewing these videos. “It is too premature” to make conclusions, he said in a phone interview. The investigation “is at its baby stages. It’s going to take months and months, if not a year or more, to come to a conclusion.”
John R. Black, a former law enforcement officer who has been an expert witness in police practices cases and specializes in analyzing decision-making, told us, “All the video does is demonstrate the need for questions,” adding that the video “by itself, can never be conclusionary.”
Yet, viewers jump to conclusions. “While video is objective evidence, interpretation is always subjective,” he said in a phone interview. The viewer attaches meaning to the video, “but that’s the viewer’s meaning.”
Readers can watch these videos and other bystander footage for themselves, including frame-by-frame breakdowns by the New York Times and Washington Post.
Stoughton said disagreements on what video in these types of cases shows are largely due to “cognitive biases,” or “unconscious processes that our brains use to make sense of the world without being overwhelmed” by filtering our perceptions “through the lenses of previous experience, identity, and expectation.” He cited two cognitive biases: motivated reasoning and confirmation bias, both tendencies that lead observers to interpret information to reinforce or confirm their identities and worldviews.
“A progressive Democrat who identifies, in part, as being anti-immigration enforcement and a MAGA Republican who identifies, in part, as staunchly supportive of the administration’s immigration crackdown are motivated to see the same incident very differently,” he said, as an example of motivated reasoning.
Video “can be highly informative,” Stoughton said. “However, the existence of video does not assure complete agreement about what happened or how the facts should be characterized.”
Black also cited “outcome bias.” The people shown in a video are making decisions without knowing how it will turn out, but viewers watch these actions in the video while already knowing the outcome. “We as a viewer of the video, we are weighing in on the outcome, not the decision,” he said.
The two early videos of the incident — the one Trump posted and a closer-up video widely circulated later on Jan. 7 — together show ICE officers approaching an SUV that appears to be partially blocking traffic on a residential street. One officer approaches the driver’s window and then reaches for the door handle. Another officer walks around the passenger side of the car and then in front of the vehicle. The shooting incident happens quickly. In less than five seconds, several actions occur: The car backs up and then moves forward, and the officer at the front of the car draws his weapon and fires, while moving to the side of the vehicle as it speeds away.
The experts we interviewed said there’s a lot more information for investigators to gather. Initially, the FBI and Minnesota Bureau of Criminal Apprehension were jointly conducting an investigation, but now the FBI is solely leading it, the BCA said in a Jan. 8 statement. Walz said that same day that “Minnesota must be part of this investigation.” In a press conference, the governor said of the FBI being solely in charge, “It feels very, very difficult that we will get a fair outcome, and I say that only because people in positions of power have already passed judgment.”
Obayashi told us having a moving vehicle “makes it much more complicated in terms of evaluation.” He said investigators will recreate what happened, including the speed, direction, where everyone was positioned. “You’re going to have to correlate all that against witness statements,” and analyze all of the available video, including any body-worn police cameras.
On Jan. 9, video that appeared to be from the shooting agent’s cell phone was obtained by several news organizations.
“It can be extremely helpful for investigators to synchronize multiple videos, which can create a way of looking at the same scene from multiple perspectives simultaneously,” Stoughton said. The investigators will also interview the agent who fired the shots, other agents and bystanders. “Witness descriptions almost inevitably disagree to some extent, but they can help shed light on what happened off camera or on how to interpret what is visible on camera.” Forensic evidence on the trajectory of the bullets “can also help shed light on the facts of what happened.”
Black said that “no video can tell you what occurs in the mind of the actor,” meaning we don’t know about the agent’s “subjective inference” and his decision-making. For example, a New York Times analysis of video from different angles said that “the vehicle appears to be turning away from a federal officer as he opened fire.” But, Black asked, could the agent have perceived that the car was turning away in time? “It has to be examined.”
We also can’t know the viewpoint of Good.
The agent’s thought process is critical to a determination of whether the use of deadly force was justified. “Police officers can generally use deadly force in two circumstances,” University of Virginia School of Law professor Rachel Harmon, an expert on policing and the law, explained in a 2021 video on the topic. “The most common is when they feel they are threatened with a use of force or a threat of force that would cause serious bodily harm or death. … And the other is when someone is fleeing a dangerous crime – when someone has engaged in a crime of violence, and are fleeing and the only way to subdue them is to use deadly force against them.”
The administration has cited the first reason. DHS also has a policy on use of force that said, as of 2023, that its officers and agents “may use force only when no reasonably effective, safe, and feasible alternative appears to exist and may use only the level of force that is objectively reasonable in light of the facts and circumstances.”
Stoughton told us there are three likely questions for the investigation: “1) Did the agent put himself into the vehicle’s path of travel unnecessarily? 2) Would a reasonable officer in the agent’s position have perceived that the vehicle’s movement presented a threat of serious bodily harm or death? And 3) if so, could the agent have reasonably dealt with the threat by stepping out of the way rather than shooting the driver? For all three questions, we will need detailed information about the timeline and sequence of events that can only come from obtaining and comparing multiple videos and other sources of evidence.”
In criticizing Colorado Gov. Jared Polis and vetoing a bill that would fund a water project in the state, President Donald Trump has claimed that people are leaving the state “in droves,” but that’s not what the available data show.
Despite having supported the project during his first term, the president wrote in a memo to Congress that he nixed the bill because it “would continue the failed policies of the past by forcing Federal taxpayers to bear even more of the massive costs of a local water project.”
But he suggested in an interview with Politico that another contributing factor was his impression that the population of Colorado was declining. In social media posts criticizing Polis, Trump repeated the claim about people moving out of the state, once citing one moving company. Demographic data and figures from other moving companies contradict the claim.
This was one of only two bills the president vetoed during his first year of this term, and the legislation had passed the House and Senate by uncontroversial voice votes. Some Colorado political insiders and observers have speculated that the veto was political retribution against Rep. Lauren Boebert — a Trump ally who represents a Colorado district affected by the project and who diverged from the president when she demanded the release of files on Jeffrey Epstein — or against Polis — a Democrat who has sparred with Trump over the incarceration of Tina Peters, a former Mesa County clerk who was convicted of Colorado state charges of compromising election equipment to undermine the outcome of the 2020 election.
The House may vote on Jan. 8 on overriding the veto, which could be successful given the broad support for the bill. Update, Jan. 9: Although 35 Republicans voted in favor of the bill, the House vote to override the veto failed.
The project it would fund — called the Arkansas Valley Conduit — would pipe reservoir water for 130 miles to about 50,000 people in an area that has naturally occurring radionuclides, including radium and uranium, in the groundwater. The AVC has a decades-long history as part of the extensive Fryingpan-Arkansas Project that brought water to users across the state after it was approved in 1962.
The cost of the AVC project so far has been over $500 million, and the total projected cost is $1.4 billion, according to an estimate based on 2023 prices from the Eastern Colorado Area Office of the federal Bureau of Reclamation, which is overseeing the project with the Southeastern Colorado Water Conservancy District. That total is roughly twice as much as the 2016 estimate, according to the bureau.
“Despite estimated project cost increases, the cost of the pipeline remains comparable to construction costs of similar pipelines currently under construction by Reclamation,” the bureau said on its website.
On Dec. 31, two days after Trump vetoed the bill, he told Politico, “They’re wasting a lot of money and people are leaving the state. They’re leaving the state in droves. Bad governor.” He also posted on his social media platform, Truth Social, “California and Colorado are two of the TOP OUTBOUND STATES IN 2025 (United Van Lines!) – In other words, PEOPLE LEAVING!!!” Later the same day, he said in a post that “people are leaving in record numbers.”
We asked the White House for clarification on the president’s reasoning for vetoing the bill and for evidence to support the claim that people are leaving Colorado “in droves.” We were directed to the president’s official explanation to Congress and got no response to the question about population shifts.
Based on Trump’s social media post, it appears that the claim comes from the annual roundup provided by the moving company United Van Lines. It reported making a total of 6,633 moves into and out of Colorado in 2025 — 2,986 were for people moving into the state and 3,647 were for people moving out of the state. That put Colorado — with 55% of its moving traffic leaving the state — among the “top outbound states for 2025.”
According to the report, the largest portion of those who left — about 31% — did so because of family obligations, and the second largest — about 23% — did so for a job.
But that’s not the only moving company that operates in Colorado, and, as NBC’s Denver affiliate, 9NEWS, noted, several other moving companies — including U-Haul, Atlas Van Lines, North American Moving Services and Allied Van Lines — reported either a slight influx, a slight outflow or neutral moving trends for the state in 2025.
Because Trump suggested that people are leaving Colorado “in droves” due to a “bad governor,” it’s also worth noting that Census data published by the website USAFacts show that since Polis took office in 2019, the moderate upward trend in the state’s population over the last decade has continued, although the data is only through 2022.
Similarly, data from the State Demography Office show comparable estimates and projections through 2025. The office estimated Colorado’s population was 5.7 million in 2019 and projected the figure grew to nearly 6 million for 2025.
We reached out to the office for more details, but didn’t receive a response. In July, however, Colorado State Demographer Kate Watkins told 9NEWS that “Colorado has, and is projected to continue to, grow faster than the rest of the United States.”
The president posted more about Polis on Dec. 31, writing in the afternoon on Truth Social: “God Bless Tina Peters, who is now, for two years out of nine, sitting in a Colorado Maximum Security Prison, at the age of 73, and sick, for the ‘crime’ of trying to stop the massive voter fraud that goes on in her State (where people are leaving in record numbers!).” He called Polis a “Scumbag” and the Republican district attorney who prosecuted Peters “disgusting,” adding, “May they rot in Hell. FREE TINA PETERS!”
Peters, who took office as the Mesa County clerk and recorder in 2019, was convicted in state court in 2024 of several charges related to breaking into county election equipment in an attempt to prove that Trump had won the 2020 presidential election, despite the fact that former President Joe Biden won both the electoral college and the popular vote — garnering 81 million votes to Trump’s 74 million, nationally, and winning Colorado with about 55% of that state’s vote compared to Trump’s 42%.
She is serving a nine-year sentence in state custody.
On Dec. 11, Trump announced on Truth Social that he would grant her a “full Pardon for her attempts to expose Voter Fraud in the Rigged 2020 Presidential Election!”
He also signed an executive grant of clemency that is dated Dec. 5.
But the president’s pardon power extends only to federal charges. Peters was convicted of state charges.
“No President has jurisdiction over state law nor the power to pardon a person for state convictions,” Polis said on Dec. 11 on X. “This is a matter for the courts to decide, and we will abide by court orders.”
State leaders have suggested that the veto may be political retribution.
Boebert has also suggested that the president’s move may have been a reprisal for her support of the Epstein Files Transparency Act, which Trump had referred to as a “hoax” and sought to discourage her from backing.
Several Democrats have claimed that the Trump administration’s Jan. 3 military operation that led to the capture of Venezuelan President Nicolás Maduro and his wife, Cilia Flores, was “illegal,” violating both domestic and international law.
Experts we consulted told us that the operation runs afoul of the United Nations Charter that prohibits unjustified uses of military force by one country against another. Experts also previously told us that the U.S. Constitution, according to an originalist interpretation, requires congressional approval for such use of force abroad. In practice, however, multiple presidents — like President Donald Trump in this instance — have unilaterally ordered military action without input from lawmakers.
In this story, we’ll review some of the legal arguments that have been made.
Several Democrats have claimed that the Trump administration’s military actions in Venezuela violated international law.
“It’s clearly illegal under international law, right?” Rep. Jim Himes, the top Democrat on the House Intelligence Committee, said on CBS’ “Face the Nation” on Jan. 4. “Full stop. U.N. charter. No question there.”
In an interview on CNN on Jan. 5, Rep. Adam Smith, the ranking Democrat on the House Armed Services Committee, called the military action “blatantly illegal.”
“We’ve signed on to a U.N. charter that says you can’t violate sovereign territory in this way, even to arrest somebody who has a indictment against them,” Smith said. “The U.N. Charter is clear. We signed on to the U.N. Charter, so therefore we were clearly breaking the law and doing a regime change operation. That’s not even debatable. And President Trump’s contempt for that law does undermine any sort of legal action going forward. Across the globe, we increasingly send the message the law is just a matter of convenience. Do what you want.”
Numerous experts in international law agree with them.
Specifically, Article 2 (4) of the U.N. Charter states that members “shall refrain in their international relations from the threat or use of force against the territorial integrity or political independence of any state.”
In a Jan. 5 statement, U.N. Secretary-General Antonio Guterres said that he was “deeply concerned that rules of international law have not been respected” and warned about “the precedent it may set for how relations between and among states are conducted.”
There are 193 members of the U.N., including Venezuela, which has been a member since 1945.
University of Pennsylvania Carey Law School professor Bill Burke-White, an expert on international law, told us via email that the military action in Venezuela was “illegal under international law in every imaginable way.”
“Under international law and pursuant to articles 2(4) and 51 of the UN Charter, the use of force is only justified in two circumstances: authorization by the UN Security Council or an act of self defense in response to an armed attack,” Burke-White said. “Neither applies here.”
“In addition,” Burke-White said, “Maduro (while a despicable individual) was the sovereign leader of Venezuela. He therefore enjoys sovereign immunity, which means a foreign government can not arrest or prosecute him.”
Secretary of State Marco Rubio and other Trump administration officials have called Maduro an “illegitimate” leader. (World leaders widely disputed Maduro’s supposed 2024 election.) And therefore, the administration’s argument goes, he can be criminally prosecuted in the United States.
That is an issue “the American courts are going to have to weigh in on,” Oona Hathaway, a professor at Yale Law School and the director of its Center for Global Legal Challenges, said in an interview with the New Yorker.
The problem, Hathaway said, “is that merely saying that he’s not head of state doesn’t then justify the use of military force in Venezuela.”
In a Jan. 5 article for Just Security, international law experts Michael Schmitt, Ryan Goodman and Tess Bridgeman agreed.
“The bottom line is, unlike the boat strikes the U.S. military has carried out to date that have occurred in international waters against stateless vessels, this operation, striking Venezuela and abducting its president, is clearly a violation of the prohibition on the use of force in Article 2(4) of the UN Charter,” the three wrote. “That prohibition is the bedrock rule of the international system that separates the rule of law from anarchy, safeguards small States from their more powerful neighbors, and protects civilians from the devastation of war.”
Echoing Burke-White’s comments, they wrote that the only exceptions are with authorization from the U.N. Security Council or “in self-defense against armed attack.” Given there was no U.N. Security Council authorization, “the sole possible legal basis for the operation would be self-defense,” they wrote.
And that is what Trump administration officials are arguing.
In an interview with Fox News on Jan. 4, U.N. Ambassador Mike Waltz dismissed the “hand-wringing” about Article 2 of the U.N. Charter, adding that Article 51 of the charter permits “a nation’s inherent right to self-defense.”
Article 51 of the U.N. charter states, “Nothing in the present Charter shall impair the inherent right of individual or collective self-defence if an armed attack occurs against a Member of the United Nations, until the Security Council has taken the measures necessary to maintain international peace and security.”
“So, in this case, you have a drug kingpin, an illegitimate leader indicted in the United States coordinating with the likes of China, Russia, Iran, terrorist groups like Hezbollah, pumping drugs, thugs and weapons into the United States of America, threatening to invade its neighbors,” Waltz said. “And at the end of the day, was the United States, was President Trump just going to let that status quo continue? Absolutely not.”
Maduro and his wife were brought to New York and indicted on cocaine-trafficking conspiracy charges.
On NBC’s “Meet the Press” on Jan. 4, Rubio echoed the defense argument.
“We can’t have a country where the people in charge of its military and in charge of its police department are openly cooperating with drug trafficking organizations. We can’t. We’re not going to allow that,” Rubio said. “These things are direct threats to the United States.”
John Bellinger, adjunct senior fellow in international and national security law at the Council on Foreign Relations, said the defense exceptions in the U.N. Charter “do not apply here.”
“President Trump has claimed that President Maduro had sent criminal gangs, including Tren de Aragua, ‘to terrorize American communities nationwide’ but there is no factual support for this statement,” said Bellinger, quoting the president’s Jan. 3 press conference on the military action. Bellinger, who served as the legal adviser for the Department of State and the National Security Council in the George W. Bush administration, noted that the administration’s own National Intelligence Council concluded in an April 7 intelligence assessment that the Maduro regime “probably does not have a policy of cooperating with [Tren de Aragua] and is not directing TDA movement to and operations in the United States.”
“The action violated international law,” Tom Dannenbaum, a professor at Stanford Law School with expertise in international law relating to armed conflict, told us via email. “This analysis does not turn on an assessment of the Maduro regime. It depends instead on the strict prohibition of the resort to military force in international relations, except in narrow and specific circumstances, none of which obtains in this case. Serious legal objections to Maduro’s regime do not eliminate the need for a legal basis to use military force in Venezuela. Under international law, the use of force on another state’s territory is presumptively unlawful.”
While the Trump administration has argued the U.S. was defending itself against drug traffickers, Hathaway told the New Yorker that argument “really doesn’t work under international law.”
“There is a right of self-defense under the United Nations charter, which allows states to use force in self-defense against an armed attack,” Hathaway said. “But it’s never been used for something like drug trafficking. And so all of these boat strikes that have been taking place over the past couple of months, which have been justified as self-defense, don’t fall within anything that anyone would recognize as self-defense under international law. Self-defense generally requires that there’s actually an armed attack.”
Dannenbaum similarly disagreed with the argument that Venezuela drug trafficking met the threshold of an armed attack on the U.S.
“Venezuela has not engaged in an armed attack against the United States or any other state on whose behalf the US could claim to be acting,” Dannenbaum said. “Nor is there any reason to believe such an attack was imminent. The concept of ‘armed attack’ captures the ‘most grave’ forms of the use of armed force. This is widely understood to entail direct injurious or destructive action. Even assuming it can be attributed to the state, drug trafficking does not satisfy that threshold and it has never been recognized as doing so, in part because the harm associated with drug use involves multiple points of intervening agency and is too far attenuated from the act of trafficking itself. The fact that drug trafficking is a serious crime does not entail an authorization to use military force against another state, even if that state’s officials are suspected of being involved in the criminal activity.”
CNN national security correspondent Natasha Bertrand reported on Jan. 3 that “Trump administration officials are internally pointing to a 1989 legal opinion and the subsequent US invasion of Panama as precedent to justify the operation that was carried out in Venezuela.”
That opinion, written by Bill Barr, then an assistant attorney general in the Office of Legal Counsel — who later served as U.S. attorney general in Trump’s first term — argues that the president “has the inherent constitutional authority to deploy the FBI to investigate and arrest individuals for violating United States law, even if those actions contravene customary international law.”
In an article for Just Security, Goodman, founding co-editor-in-chief of Just Security and a law professor at New York University School of Law, argued that the Barr memo is “flawed” and that it reaches “a radical conclusion that cannot withstand serious scrutiny.”
As for a comparison to the U.S. military action to capture General Manuel Noriega in Panama in 1989, the authors of the earlier Just Security article noted several significant differences in that case.
“The United States claimed to be acting by invitation of the rightful Head of State,” the authors wrote. And, they said, “the United States acted after the Panamanian National Assembly declared a state of war against the United States, and after forces under Noriega’s command” had — as noted by President George H.W. Bush at the time– “killed an unarmed American serviceman; wounded another; arrested and brutally beat a third American serviceman; and then brutally interrogated his wife, threatening her with sexual abuse.”
Regardless, experts told us the U.S. veto power would block any potential United Nations consequences, such as sanctions. There are, nonetheless, political implications.
“The United States was one of the principal drafters of the UN Charter and is one of five permanent members of the Security Council, entrusted with ensuring international peace and security,” Bellinger told us. “When the United States blatantly violates the UN Charter, it destroys the global respect it has built over many decades as a nation committed to the rule of law and a force for good and encourages other rogue states like Russia and China to ignore the UN Charter. The United States loses its global credibility to criticize the Russian invasion of Ukraine or a potential Chinese invasion of Taiwan when it uses force in violation of the UN Charter based on false justifications.”
Several Democratic lawmakers have also claimed that the operation in Venezuela, without congressional approval, violated domestic law.
“Maduro is a horrible, horrible person, but you don’t treat lawlessness with other lawlessness, and that’s what’s happened here,” Senate Minority Leader Chuck Schumer told ABC’s George Stephanopoulos in a Jan. 4 interview. “They went inside Venezuela, bombed civilian as well as military places, and it’s a violation of the law to do what they did without getting the authorization of Congress.”
Rep. James P. McGovern, the ranking member of the House Rules Committee, made essentially the same argument in a Jan. 3 statement.
“President Trump did not seek congressional authorization for this use of force, and Congress did not grant it. Under our Constitution and the law, that makes this action illegal,” he said.
Hathaway, the director of Yale’s Center for Global Legal Challenges, told the New Yorker that U.S. constitutional law “requires the President to go to Congress to seek authorization before using force against another country.”
Republicans in the Trump administration and in Congress have argued that no congressional authorization was needed.
“This is an operation that did not require prior consent of Congress, prior authorization of Congress,” House Speaker Mike Johnson said in a Jan. 5 press conference. “It required notification of Congress. It’s well within Article II” of the U.S. Constitution.
Johnson said that he spoke to the president and the secretaries of state and defense “within hours” after the mission commenced. “The first call was from Marco Rubio at about 4 a.m., so they’ve done everything that they were supposed to do. This was an appropriate action,” he said.
The day prior to Johnson’s press conference, on NBC’s “Meet the Press,” Rubio himself defended acting without getting the go-ahead from Congress.
“This was not an action that required congressional approval,” Rubio said to the show’s host, Kristen Welker. “In fact, it couldn’t require congressional approval because this was not an invasion. This is not an extended military operation. This was a very precise operation that involved a couple of hours of action. It was a very delicate operation too. It was one that required all these conditions to be in place at the right time in the right place.”
Rubio said going to Congress beforehand could have led to “leaks” that “would have endangered the mission and gotten people killed.”
Going forward, he said, “we will seek congressional approval for actions that require congressional approval … otherwise they will get congressional notification.”
As we’ve written, Article I, Section 8 of the U.S. Constitution assigns the power “To declare War” to Congress. Meanwhile, Article II, Section 2 of the Constitution says that the president is the commander in chief of the armed forces.
For our June story, which was about whether Trump’s decision to bomb Iranian nuclear facilities was legal, Peter Shane, a constitutional law scholar and adjunct professor at New York University School of Law, told us that “there is so much disagreement about how the Constitution should be interpreted with regard to the unilateral presidential deployment of military force.”
He said in an email, “Under the most persuasive reading of the Founding era, the Constitution does not authorize Presidents to deploy military force abroad without advance congressional authorization.” Yet, he said, it has “long been the position” of the Justice Department’s Office of Legal Counsel “that history has ratified unilateral presidential deployments of military force as long as (1) the deployment serves ‘sufficiently important national interests,’ as judged by the President, and (2) the deployment does not portend a ‘prolonged and substantial military engagement, typically involving exposure of U.S. military personnel to significant risk over a substantial period.'”
Kermit Roosevelt, a constitutional expert and professor at the University of Pennsylvania Carey Law School, had a similar interpretation.
“The Constitution says that Congress has the power to declare war, and the records of the Constitutional Convention are pretty clear that the drafters did not want to give one person the power to take the United States into war,” Roosevelt told us for the same story. “However, presidents have done things that count as acts of war under international law without congressional authorization, like the Libya bombings [under then-President Barack Obama], and no one has stopped them, so our practice has departed from the text and original understanding.”
As for notifying Congress of military action, the 1973 War Powers Resolution passed by Congress requires presidents within 48 hours “to report to Congress any introduction of U.S. forces into hostilities or imminent hostilities,” as the Congressional Research Service has explained.
Once the military action is reported, the resolution “requires that the use of forces must be terminated within 60 to 90 days unless Congress authorizes such use or extends the time period.” It also “requires that the ‘President in every possible instance shall consult with Congress before introducing’ U.S. Armed Forces into hostilities or imminent hostilities.’”
Roosevelt previously told us that the resolution doesn’t mean the president “can do what he wants for 48 hours before notifying Congress, or for 60 days even if Congress doesn’t” give its approval. He said, “That’s not consistent with the Constitution and it’s not consistent with the purpose and policy section of the WPA, which says that the intent is to make sure that the President’s power to engage in military action is exercised ‘only pursuant to (1) a declaration of war, (2) specific statutory authorization, or (3) a national emergency created by attack upon the United States, its territories or possessions, or its armed forces.'”
He explained that the “48 hour and 60 day windows are supposed to be relevant to presidential responses to attacks, and the President is not supposed to be able to initiate wars at all.”
But the Trump administration says that the U.S. is not at war with Venezuela.
“As Secretary Rubio has said, there is no war against Venezuela or its people,” Waltz, the U.S. representative to the United Nations, said in a U.N. Security Council briefing on Jan. 5. “We are not occupying a country. This was a law enforcement operation in furtherance of lawful indictments that have existed for decades. The United States arrested a narcotrafficker who is now going to stand trial in the United States in accordance with the rule of law for the crimes he’s committed against our people for 15 years.”
However, Trump, who also has said “we’re not” at war with Venezuela, has not ruled out sending troops back into the country.
In the end, Jack Goldsmith, a Harvard Law School professor and a nonresident senior fellow at the American Enterprise Institute, argued that the debate about the legality of unilateral presidential uses of force has little significance.
“Immediately after these operations happen, every time this happens – Libya, Kosovo, Iran, all of these unilateral uses of force without congressional authorization – we immediately jump to the law and commentators immediately say this is illegal, depending on whether they like the war or not, or they defend it as being lawful, and we have this debate about whether it’s lawful or not, and I frankly think it’s kind of a meaningless debate in almost every circumstance,” he said in a Jan. 5 discussion with Bob Bauer, a legal scholar and New York University School of Law professor of practice.
“The issue is, why has Congress given the president this massive military force without constraints? Why does it continue to acquiesce in the president’s use of force? Why isn’t Congress exercising its constitutional prerogatives and constitutional responsibilities to check these things?” Goldsmith asked. “The lawyers tend to flee to the legal arguments. I think the legal arguments in this context are not terribly meaningful and that the focus should be on the politics of this. And the politics are that Congress has let the president get away with it knowingly across administrations, left and right, Democrat and Republican. And the Democrats tend to complain about Republican uses of force and vice versa. But all of this stuff takes place in the rhetoric of law that I think is largely meaningless.”
He said that unilateral use of force by the president is not an issue that has been adjudicated by the courts and he doubts that it will be.
“So, there’s no judicial force to stop that,” he told Bauer. “Only Congress exercising its political prerogatives, perhaps making legal arguments, can check that.”
Schumer said that he and fellow Democratic Sens. Tim Kaine and Adam Schiff, as well as Sen. Rand Paul, a Republican, will force a Senate vote this week on a war powers resolution that would require congressional approval for further military action in Venezuela.
Many doctors agree with the Food and Drug Administration’s recent decision to remove the black box warnings on at least some forms of hormone therapy used to treat the symptoms of menopause. But in making the announcement, health officials misleadingly suggested that women could take the drugs for long-term benefits to the heart and brain. Menopausal hormone therapy is not currently recommended for those uses.
On Nov. 10, the FDA announced it would be removing the black box warnings for increased risk of cardiovascular disease, breast cancer and probable dementia on all hormone treatments for menopause. Such products include a variety of formulations of estrogen, often with another hormone, that work to alleviate symptoms such as hot flashes, night sweats and vaginal dryness, which can be severe in some women.
The warnings were first applied in 2003, following the results of a large randomized controlled trial that was part of the Women’s Health Initiative. This study, funded by the National Institutes of Health to better understand how to prevent disease in older women, was widely misinterpreted as finding that risks of menopausal hormone therapy, or MHT, outweighed benefits for managing menopause symptoms. Use of MHT plummeted.
In the intervening years, it has become clear that certain forms of MHT, such as oral pills that act systemically, or throughout the body, do have some risks, but can be safely used to treat symptoms in most women without risk factors when started within 10 years of menopause. This is when symptoms are most likely anyway. Other forms of MHT, such as vaginal estrogen, pose little if any risk. Menopause is when a woman stops menstruating; a woman is considered postmenopausal once she has gone a year without a period.
Medical groups such as the American College of Obstetricians and Gynecologists have long recommended MHT after considering an individual’s risks and benefits and have petitioned the FDA to remove the black box warnings for low-dose vaginal estrogen. They do not, however, advocate the use of hormones for overall health when a woman does not have any symptoms, due to a lack of convincing evidence.
In making their black box announcement, FDA Commissioner Dr. Marty Makary and Health and Human Services Secretary Robert F. Kennedy Jr. misleadingly extolled the benefits of MHT in preventing cardiovascular disease and dementia.
“Hormone replacement therapy has been found to reduce the risks of cardiovascular disease and mortality by as much as 50%, Alzheimer’s disease by 35%,” Kennedy said near the beginning of the Nov. 10 press conference announcing the change.
“By a large body of evidence, there are now recognized to be profound long-term health benefits that few people, even physicians, know about,” Makary later said of hormone therapy, calling it “life-saving.”
“What are we doing not offering women this potentially powerful treatment? With few exceptions, there may be no other medication in the modern era that can improve the health outcomes of women on a population level than hormone replacement therapy,” he added.
Kennedy and Makary made similar claims in a variety of subsequent appearances, including Kennedy’s citation of the same figures in a Dec. 2 Cabinet meeting.
Experts told us their statements don’t reflect the full scientific literature on the topic.
“The totality of the data do not support a preventive benefit of hormone therapy for these diseases,” Dr. Nanette Santoro, a menopause researcher at the University of Colorado Anschutz, told us. “One must selectively pull out specific numbers from specific studies to come up with a miraculous reduction in risks.”
No guidelines, neither from ACOG, the Menopause Society, the International Menopause Society nor the Endocrine Society, she noted, recommend hormone therapy to prevent cardiovascular disease or dementia.
Makary and Kennedy also downplayed risks of systemic MHT, implying that breast cancer risks are not borne out by the data. This is misleading and does not tell the full story.
“They’ve systematically cherry-picked things that show benefit and that diminish risk,” Dr. Martha Hickey, a menopause clinician and researcher at the University of Melbourne, told us.
“Providers should always have a nuanced conversation about the risks and benefits of systemic hormone therapy with their patients. Each woman is different, and this conversation needs to be tailored to the needs and priorities of each woman,” Rebecca Thurston, a menopause researcher at the University of Pittsburgh who focuses on cardiovascular and neurocognitive health, told us. She emphasized that MHT is highly effective for hot flashes and night sweats and can also prevent menopause-associated bone density declines but is not recommended for the prevention of heart disease and dementia “based on the highest quality science.”
The FDA did not respond to a request for comment.
In touting the benefits of MHT, Makary and Kennedy repeatedly claimed that hormone therapy has been found to lower the risk of Alzheimer’s disease by 35% and reduce cognitive decline by 64%. The numbers were also cited in an HHS fact sheet.
Both reflect findings in individual scientific studies, but they are cherry-picked and not representative of the overall literature.
Pauline Maki, a menopause and cognition researcher at the University of Illinois College of Medicine, explained in a series of social media posts that the 35% figure is “misleading and inaccurate in light of what we now understand.” It comes from a 1996 case control study of a single retirement community in Laguna Hills, California.
The study looked at how often women with an Alzheimer’s disease or dementia diagnosis on their death certificate had self-reported using hormone therapy, compared with those who did not have such diagnoses noted. It found that women with Alzheimer’s were less likely to have said they used hormones, with hormone use associated with a 35% lower risk of the disease.
While that might sound pretty good, Maki said, this doesn’t prove that it’s the hormones that made the difference, as other factors associated with hormone use could be driving the result instead.
There are also much larger and more recent case control studies that Makary and Kennedy did not mention. While the cited Laguna Hills study drew from a population of around 9,000 and involved fewer than 1,500 women who died 30 or more years ago, three population-wide case control studies have been published in the past six years, each with 60,000 or more participants.
“When you look at those studies, a very, very different result emerges,” Maki said in a video post. “Far from reducing the risk of Alzheimer’s disease, those studies found zero evidence for a reduction, and in fact, found an elevated risk.”
Maki said that women should not be concerned about increasing their dementia risk if they are using hormones to alleviate menopause symptoms. “But if you use it for primary prevention, particularly long term, there’s no evidence of benefit,” and there could be potential harm, she said.
The second study Kennedy and Makary have cited is a 2005 Danish follow-up study of 343 women who had previously been in a randomized controlled trial and had received hormone therapy or placebo years earlier. Researchers administered a cognitive screening test and found that while there was no difference in the average scores among those who ever took hormones versus those who never did, the subset of women who took hormone therapy for two to three years had a 64% lower risk of testing positive for cognitive impairment.
Maki told us that the study had a better design in terms of exposure to hormone therapy, but was “weak in its measure of cognitive impairment and is weak methodologically as only a subset of women in the original study participated in this follow-up.” She said it was odd to highlight either this paper or the Laguna Hills paper given all the other studies that have been conducted on the subject over the past 20 years.
When randomized controlled studies have been done, they have failed to find that hormone therapy has cognitive benefits in recently postmenopausal women. Four such trials have found no effects — good or bad — on cognition.
One randomized controlled trial — the WHI Memory Study — found that at 18 years of follow-up, women were 26% less likely to die of dementia if they had taken one type of an oral estrogen-only therapy. These women had all had hysterectomies, allowing them to take systemic estrogen without progesterone. (In women with intact uteruses, progesterone or a synthetic form called progestin needs to be added because estrogen on its own can increase the risk of uterine cancer.)
But the absolute benefit was very small, and the authors said the result should be interpreted with “particular caution.” The same trial found earlier that a combined estrogen and progestin therapy more than doubled the risk of probable dementia in postmenopausal women 65 years and older.
Some scientists have hypothesized that the timing of MHT matters, such that hormone therapy might benefit the brain if given early in the menopause transition or before disease sets in — and then shift to being neutral or harmful later. But as the Menopause Society’s 2022 position statement on MHT explains, the concept has not “been definitively supported” in randomized controlled trials.
Based on “good and consistent scientific evidence” — the highest graded recommendations — the society concluded that “[i]n the absence of more definitive findings, hormone therapy is not recommended at any age to prevent or treat a decline in cognitive function or dementia.”
Makary and Kennedy have frequently claimed that hormone therapy dramatically cuts the risk of heart disease, casting it as a clear and definitive finding.
While there is some evidence of a cardiovascular benefit when MHT is started within 10 years of menopause or before the age of 60, this remains a hypothesis that has not yet been confirmed in trials.
“Until we have that next trial that would answer these questions, we can’t make these very large sweeping claims,” Dr. Chrisandra Shufelt, a women’s health internist at the Mayo Clinic in Florida who has studied the impact of hormones on cardiovascular disease, told us.
Both health officials have specifically said that hormone therapy slashes cardiovascular disease risk by 50%. HHS has used the same statistic in its press release and fact sheet.
The study often cited for this, however, is a 1991 review that specified that those findings pertained to oral estrogen-only hormone therapy — the kind given to women without uteruses — and needed to be confirmed in a randomized controlled trial.
Indeed, the review predates findings from the 2002 and 2004 WHI studies, which were specifically done to test whether hormone therapy actually did prevent cardiovascular disease in primarily healthy postmenopausal women.
“There’s observational data and there’s lots of it,” Marcia Stefanick, a WHI investigator and chronic disease prevention researcher at Stanford University, told us, noting that’s why the WHI study was done in the first place. “We know that the women who are using menopausal hormones were very different from the women who weren’t,” she explained, adding that they were “less obese, less likely to smoke, more physically active, more highly educated, less likely to eat high fat diets and have salt in their diet.”
At the time, hormones were commonly prescribed for prevention and were recommended by medical societies for that purpose.
“What piqued our interest in the late 80s and early 90s was that hormone therapy was increasingly being used for other indications — that is, prevention of cardiovascular disease in particular,” Dr. Jacques Rossouw, the project officer for the study from its inception until his retirement in 2014, told us. He emphasized that he was speaking to us in his personal capacity and not on behalf of the WHI investigators nor his former employer, the NIH.
Surprising many, when the WHI study testing MHT with oral estrogen and progestin was stopped after five years in 2002, it did not identify cardioprotective effects — and in fact the medications appeared to increase risk for the group as a whole. Nor did the oral estrogen-only part of the study find heart benefits when it halted in 2004. (A separate trial known as HERS similarly found no cardiovascular benefit with MHT in women with existing coronary disease, with an increased risk of blood clots, contrary to earlier observational studies.)
When later stratified by age, and after longer follow-up, the WHI results suggested that the cardiovascular risks of hormone therapy are generally lower in younger women closer to menopause and higher in older women starting therapy 10 years or more after menopause. These risks dissipated over time, and were more evident in women taking combined therapy. For younger women 50 through 59 years of age taking estrogen alone after 13 years of follow-up, the study pointed to a reduced risk of heart attack and coronary heart disease.
“If you look at the estrogen and progestin trial, there’s no benefit for younger women at any point for anything,” Stefanick noted. “It’s only in the estrogen-only trial, and those are women who had a hysterectomy.”
In trying to understand why the observational studies diverged from the trial data, these subanalyses, combined with other studies, including in monkeys, led to the so-called “timing hypothesis.” It proposes that estrogen has beneficial effects on the heart if given early and before plaques have formed in arteries, but is neutral or can be harmful later in life when women have established plaques.
As several guidelines document, there is wide agreement that timing affects the cardiovascular risk of hormone therapy — and that oral MHT is safe in most younger postmenopausal women who have bothersome symptoms. But there is far less agreement that this means MHT is preventing cardiovascular events in these women and that hormones should be given for the purpose of preventing heart disease.
Yet another WHI subanalysis published this year found that among the subset of younger women with moderate or severe hot flashes and night sweats in the trials, both estrogen-alone and combined MHT reduced symptoms without changing atherosclerotic cardiovascular disease risk. But for postmenopausal women age 70 and older with these symptoms, that risk was increased in both cases.
The WHI studies tested just one dosage of a particular oral estrogen and progestin, and it is unclear if the results apply to other dosages, types or modes of delivery. While Makary and others have emphasized that newer products may have reduced risk, by the same token, it hasn’t been shown that they would necessarily show any cardiovascular disease benefit.
“Most of us do believe it’s safer, but being safe is not the same as being beneficial,” Stefanick said, speaking of transdermal estrogen, a systemic product that is widely considered safer for the heart than oral formulations since it bypasses the liver. She added that she was not aware of any evidence of transdermal formulations showing heart disease benefits.
Makary has also referenced a 48% decline in fatal heart attacks with MHT, pointing in the press conference to a review published in Circulation. The 2023 review, which Shufelt co-wrote, was describing a subgroup finding in a 2015 Cochrane systematic review. It notably did not back the use of hormones to prevent heart attacks, and stated that it is “appropriate that no medical societies” recommend MHT for that purpose.
While the overall finding of the Cochrane review was that MHT did not protect against mortality or cardiovascular disease, when broken down by timing of therapy, a subanalysis found there was a 30% risk reduction of death from any cause and a 48% reduced risk of coronary heart disease (defined as cardiovascular deaths and nonfatal heart attacks) in women starting hormone therapy less than 10 years after menopause.
These results were largely driven by the three largest trials, Shufelt told us, and were only possible because the analysis pooled results from studies using different types of MHT, including both oral estrogen alone and combined therapy. One of the included trials is a 2012 Danish study of around 1,000 participants that was not blinded and did not use a placebo. The Cochrane review itself notes that if the Danish study is not included, the findings would not be statistically significant (see table 3). Moreover, the review found an increased risk of blood clots in veins in the younger subgroup — a fact Makary and Kennedy never mention.
The authors of the Cochrane review said in a commentary that their analysis of younger participants “should be interpreted with caution due to its post hoc nature and is therefore not adequate to make recommendations for its use to prevent cardiovascular disease in this population.”
In addition to studies looking at health outcomes, there are two smaller randomized controlled trials that have assessed whether there might be cardiovascular benefits of MHT when given to younger postmenopausal women. A 2014 study using a lower dose of estrogen failed to find any beneficial effect on atherosclerosis progression after four years.
A 2016 trial of around 650 participants found that in women within six years of menopause, MHT did appear to stall the thickening of the carotid artery. However, there was no impact on two other secondary measures of coronary atherosclerosis.
Shufelt said that it is not clear that the observed slowing of artery thickening is indicative of a cardioprotective effect. Typically, the thickness is only concerning for preclinical heart disease if it reaches a certain level, and the women still had normal thicknesses, she said. She likened the study results to slightly lowering a person’s blood pressure from an already normal pressure.
Shufelt said the studies were important because they showed that hormone therapy doesn’t increase risk in these populations, but “we’re not there yet to say that it prevents disease.”
Kennedy and Makary both have emphasized that the WHI results were misinterpreted, and use of MHT subsequently fell. This narrative is broadly correct, but the officials misled on exactly how the study was misinterpreted, downplaying statistically significant findings on breast cancer risk.
The 2002 WHI study was “not statistically significant, but it triggered a media frenzy and led to the FDA applying unscientific black box warnings to all hormone replacement therapy products in 2003,” Kennedy said during the Nov. 10 press conference.
Makary also emphasized that the WHI breast cancer results were not statistically significant. “If we don’t have statistics, then we don’t have science,” he said.
Rossouw, the former WHI project officer, called this portrayal of breast cancer risk and WHI “just dead wrong.”
The WHI was stopped around three years early in 2002 after an independent board of researchers saw that breast cancer risk had reached a level that they had decided in advance would be unacceptable. Clinical trials are required to have such a board of safety monitors. The data also showed risks of blood clots and strokes, while failing, as we’ve said, to substantiate the idea that hormone therapy could prevent cardiovascular disease. The WHI researchers concluded that, given its overall balance of risks and benefits, MHT could not be recommended to prevent chronic disease and that it would not be ethical to continue the trial.
Rossouw was the first author of the 2002 WHI paper released in conjunction with the termination of the study. This is the publication Makary and Kennedy were referring to when they cited breast cancer results that were not statistically significant. But Rossouw explained that these data were preliminary. The women stopped their treatments under the study protocol after a median of 5.6 years. The researchers published their 2002 paper based on the 5.2 years of data available at the time. “There’s a lag,” he explained. “When you stop a trial early, there’s some data that are in process that you have not yet analyzed.”
The researchers were subsequently able to analyze the data collected in the final months of the trial. “When we did the full analysis and published those data, the breast cancer risk in the estrogen-progestin trial was statistically significant,” he said. The researchers wrote in a 2003 study that they had found a 24% increase in breast cancer cases in women who were randomly assigned to receive the combined hormonal therapy.
Furthermore, as the researchers continued to follow the women for years after the trial ended, they repeatedly found a statistically significant increased risk of breast cancer for combined MHT, both at 13 years and 20 years of follow-up. The WHI ultimately showed a decreased risk of breast cancer in women who took estrogen-only therapy.
The WHI investigators wrote in a Nov. 12 response to the FDA that “combination estrogen plus progestin increased the risk of breast cancer irrespective of age and this risk became more significant over time in the trial and with longer duration of follow-up.”
Some observational studies also have found an increased risk of breast cancer associated with use of MHT. One meta-analysis published in 2019 found that taking MHT was associated with increased risk of breast cancer even among people who took it between one and four years, with increasing risk the longer people took the therapy.
Hickey called the evidence showing an increased risk for breast cancer from combined MHT “strong and consistent.” She added that it makes mechanistic sense that hormone therapy might have some impact on breast cancer. “I think with breast cancer, there’s a very strong biological mechanism by which menopausal hormone therapy increases the growth of existing breast cancers and possibly the initiation of new breast cancers,” she said.
In general, practice guidelines support the use of MHT for troublesome menopausal symptoms while urging doctors to inform patients about possible risks and benefits.
“Women should be counseled about the risk of breast cancer with hormone therapy, putting the data into perspective, with risk similar to that of modifiable risk factors such as two daily alcoholic beverages, obesity, and low physical activity,” the Menopause Society advises doctors, for example.
“Hormone therapy does confer some risk, and so what we don’t want to do is overgeneralize or underestimate that risk, because it potentially could be harmful to some people,” Dr. Monica Christmas, director of the menopause program at University of Chicago Medicine and associate medical director of the Menopause Society, told us.
People who have already been diagnosed with breast cancer are typically recommended to avoid systemic MHT, according to the group’s guidelines, although it may be an option in specific cases. Vaginal estrogen, which is applied topically, is an option for those experiencing vaginal symptoms.
What some people arguably misinterpreted were the implications of the WHI results for treating menopausal symptoms.
The 2002 study notably did not say that the trial showed that the risks of MHT outweighed its benefits when used to treat troublesome hot flashes and night sweats that come with menopause. Investigators, including Rossouw, stated this at the time.
However, this nuance sometimes was lost as study authors, communications officers, journalists, doctors and the lay public interpreted and communicated the WHI results. Many left with the impression that the researchers had found that the risks of MHT outweighed the benefits in general, and not just for preventing chronic disease. In 2001-2002, nearly 39% of women between ages 52 and 65 used MHT. As of 2017-2020, fewer than 5% did.
Makary also dismissed the WHI data by saying that it only applied to an older progestin. “Today, hormone therapy is available in formulations that do not appear to carry the same increased risk of blood clots or breast cancer that was seen in earlier studies,” he wrote in a Nov. 10 viewpoint published in the Journal of the American Medical Association. There is some support for this idea, but this conclusion is not certain.
The Menopause Society guidelines say that some “but not all” of the available data suggest a lower breast cancer risk from certain hormones compared with the type tested in the WHI study. There are no data from randomized trials to tease apart whether breast cancer risks vary by hormone type.
For months, President Donald Trump or members of his administration have used federal data showing a large increase in employment for U.S.-born workers and a decrease in employment among foreign-born workers to claim that “all net job creation” in his second term has been for citizens. And for months, multiple economists and labor experts have said that officials should not do that because these specific figures are misleading.
The figures can mislead because the reported levels of native- and foreign-born workers are influenced by predetermined population estimates for 2025 that the Census Bureau calculated in 2024.
In an August post on Substack, Jed Kolko, a senior fellow at the Peterson Institute for International Economics, wrote that “the apparent boom” in employment of workers born in America “is just a statistical artifact” attributable to the way the population and employment estimates are determined.
“If someone is reporting the increased native-born employment, they are ignoring warnings by the Census Bureau not to do that,” he told us in an interview.
But that’s exactly what Trump and administration officials have done repeatedly.
“Before I entered office, 100% of all new net jobs were going to migrant workers,” Trump said during Dec. 9 remarks in Mount Pocono, Pennsylvania, for example. “Think of that, 100% of new jobs were going to migrants. These are government numbers, by the way. These are not Trump numbers. These are government numbers because they say, ‘Well, did Trump come up with these numbers?’ No, I didn’t … Migrant workers and illegal aliens got 100%. But since I took office, 100% of all net job creation has gone to American citizens.”
He then repeated a version of the claim about net job growth for only U.S. citizens in his prime-time address to the nation on Dec. 17.
Data from the Bureau of Labor Statistics — touted in a Dec. 16 post on the White House website — do show that this year native-born employment increased by almost 2.7 million from January to November. On the other hand, employment for foreign-born individuals decreased by 972,000 in that period.
Trump is wrong to use foreign-born employment to mean “migrant workers and illegal aliens.” BLS says the foreign-born category includes “legally-admitted immigrants,” some of whom may have since become citizens, “refugees, temporary residents such as students and temporary workers, and undocumented immigrants.”
In addition, during Joe Biden’s presidency, the data show an increase of 7.5 million in native-born employment, more than the 6.5 million increase in foreign-born employment.
BLS publishes this employment data, which is based in part on its Current Population Survey, or CPS, a monthly survey of 60,000 households conducted by the Census Bureau for BLS. But the figures shouldn’t be used to make such comparisons, some experts have said.
One of those experts, Kolko, who is also a former undersecretary for economic affairs at the Department of Commerce during the Biden administration, explained the reasons why the data are questionable in his August post. He said that Trump administration officials and others who had pointed to the BLS data to claim that there had been a massive increase in native-born employment were guilty of committing a “multiple-count data felony.”
At the time, the official figures showed that native-born employment was up 2.5 million through Trump’s first six months back in office.
“The statistical agencies explicitly warn that these data” from the CPS “are not suitable for sizing and trending the foreign-born and native-born populations,” Kolko said. He pointed to a September 2024 working paper by Census Bureau staff that said the bureau, because of the survey’s small sample size, “routinely cautions against using the CPS to estimate the size and the geographic distribution of the foreign-born population when other data are available.”
“In fact,” Kolko wrote, “the apparent boom in native-born employment is just a statistical artifact, arising from arcane rules about how the data are constructed and population levels are determined.”
Those arcane rules, he told us in an interview, involve the household survey and predetermined population estimates for 2025 that the Census Bureau calculated in 2024. Those “population controls,” as he referred to them, significantly influence the reported totals for native- and foreign-born workers.
“The way the CPS works, the foreign-born and native-born population add up to a predetermined forecast that was made last year,” he said by phone. “So, a big decline in the reported foreign-born population” based on the survey “is going to be offset by a reported increase in the native-born population.”
As an extreme example, Kolko wrote in August that if the entire foreign-born population vanished from the U.S., the CPS would automatically report that the native-born population increased by millions of people to equal the predetermined estimate of the total population.
And when the estimated native-born population increases, so does the estimated number of U.S.-born workers, as Ben Zipperer, senior economist for the left-leaning Economic Policy Institute, explained in a September article.
Dean Baker, the founder and senior economist for the Center for Economic and Policy Research, another left of center group, said in a Dec. 1 analysis that there are “three obvious reasons why the CPS would show fewer foreign-born workers” in 2025.
One reason, he wrote, “is that some number of immigrants have actually left the country,” either leaving on their own or being deported. Another reason is that more immigrants, even ones in the country legally, may be reluctant and not respond to the survey. Finally, “immigrants may not answer the survey accurately,” meaning that some foreign-born residents may say they were born in the U.S. when they were not, he said.
Baker noted that BLS data show that while the reported foreign-born population 16 and older has declined since last year, the native-born population has increased by more than 5 million — a figure that he suggested is not believable. That is how the Trump administration gets “the explosion in employment for the native-born they are boasting about,” he said.
Kolko also said the reported increase in the native-born population is not realistic.
“The rate of immigration is slower this year, and it’s possible that the foreign-born population has declined,” he told us. “Immigration policy can cause the foreign-born population to grow faster or more slowly than forecast. But, in contrast, the native-born population typically grows at a predictable rate, because that’s based on fertility rates, the age distribution and mortality rates. So, aside from something like a pandemic, the native-born population typically doesn’t grow faster or slower than expected.”
“That’s why it is not plausible for the native-born population to jump the way it was reported in the CPS, and the way the CPS is constructed explains why we see this increase,” Kolko said.
Notably, data from a different monthly BLS survey of businesses, called the Current Employment Statistics, or CES, show that total U.S. employment increased by just 499,000 workers, on net, from January to November. That’s more than 1 million fewer net jobs added than the estimated increase of almost 1.7 million according to the CPS, which is the only survey of the two that breaks down native-born and foreign-born employment.
“We might expect a difference, since these are from different surveys (native/foreign from the CPS, total jobs from CES), but a difference of 1 million jobs in just 10 months is pretty big!” Jeremy Horpedahl, an associate professor of economics at the University of Central Arkansas, wrote in a Dec. 17 blog post.
We reached out to the White House about Trump’s claims, but didn’t receive a response.
Rather than employment levels, Kolko told us to look at the reported unemployment rates, as he also suggested in his August piece.
“The unemployment rate is the best information the CPS offers about the native born and the foreign born. Ignore the levels of population and employment: they mislead,” he wrote.
David J. Bier, director of immigration studies at the libertarian Cato Institute, also told us to focus on the unemployment rate, because he said that is what the CPS was really designed to determine.
“The survey is meant not to establish how many people are in the United States, or how many people are in any subcategory. It’s meant to figure out what the people in the United States are doing,” he said. “Are they working? Are they not? Are they retired? Are they in school? That’s what the survey is supposed to do, and it’s supposed to look at the rate at which these things are happening. … That’s where the survey data is useful.”
The most recent BLS data show that the unemployment rate for the native-born population has not improved; it was 4.3% in November, the same as it was in January. Meanwhile, the unemployment rate for the foreign-born population was 4.4% last month, down from 4.6% at the beginning of the year.
Bier said the unemployment rate is a more reliable statistic because it’s not dependent on the number of people in the country.
“It’s really dependent on the number of people surveyed. And if you survey enough people, you’re going to get pretty close to the actual distribution of what those people are doing,” he said.
Kolko told us that the BLS only publishes the native-born and foreign-born employment levels to be transparent about the data that underlie the calculation of the unemployment rate. But the rates ultimately are not affected by the population controls in the CPS, he said, “so it is fine to look at the native-born unemployment rate and the foreign-born unemployment rate.”
In a Dec. 17 post on X, Kolko again advised the public: “Do not look at native-born LEVELS of anything — employment, unemployment, labor force, or population. These stats may be official but they are meaningless.”
President Donald Trump and former Secretary of Transportation Pete Buttigieg have sparred over the condition of the air traffic control system, which is complex and carries a history of planned upgrades and overhauls that stretches back decades.
Trump has promised since he took office to update the system and, in December, awarded a contract with an initial $12.5 billion payment to Peraton to deliver on the Brand New Air Traffic Control System plan that he announced in May.
As he has touted his plan, Trump has also cast blame on the Biden administration for letting the system deteriorate. For example, the president referred to Buttigieg on Nov. 10, saying, “he spent billions of dollars trying to patch together our air traffic control system, which was a conglomeration of all different systems in all different cities. He spent — they had hundreds of companies working on it and they were spending billions of dollars. And when they turned it on, it didn’t work, it didn’t even work a little bit. That’s why you had a helicopter crashing into an airplane.”
Trump has made some version of this claim multiple times this year.
Buttigieg responded on Nov. 10 that the president’s claim was “false and confusing” and that the Biden administration had begun “a long-term communications fix that is still underway that he is now passing off as his idea.”
Neither one of their claims is quite right.
It’s true that the Trump administration has devoted more funding to upgrading the system than the Biden administration did, but experts also told us that much of Trump’s plan is an extension of a project that began in 2003 and continued under Biden.
We’ll explain what the state of the air traffic control system is and what each administration proposed to do about it.
As for Trump’s suggestion that Biden-era projects were responsible for the midair collision between a U.S. Army helicopter and a passenger plane on Jan. 29, that’s not supported by the National Transportation Safety Board investigation so far. The investigation is still ongoing, but the initial report published on March 7 cited a yearslong problem with helicopters and planes being too close to each other. “Existing separation distances between helicopter traffic operating on Route 4 and aircraft landing on runway 33 are insufficient and pose an intolerable risk to aviation safety by increasing the chances of a midair collision,” the report said.
The U.S. air traffic control system is comprised of more than 400 towers across the country that shuttle millions of passengers to and from the nation’s airports every day.
“This is an incredibly complex system,” Lance Sherry, director of the Center for Air Transportation Systems Research at the College of Engineering and Computing at George Mason University, told us in a phone interview.
“You can’t turn this off and start over,” he said of updating the system. “You’ve got to change the tires while it’s going 100 miles per hour on the highway.”
The system is a network that broadly involves communications from the ground to aircraft in the sky — which requires each airline to equip planes with compatible technology — and management of air traffic flow. Communications and navigation are done by both radio and satellite-based technology.
“[M]odernization has long been plagued by delays, cost overruns and under-delivery of promised benefits,” John Strong, a professor at the College of William & Mary who serves on the National Academy of Sciences Committee on air traffic control, told us.
He gave an overview of efforts starting in 1984, when IBM led the implementation of the Advanced Automation System, which had originally been proposed to cost $2.5 billion but ended up costing more than twice that when it was restructured and largely cancelled 10 years later without having been completed.
Then, in 2003, the Federal Aviation Administration began what Strong called “[t]he most ambitious recent project” — the Next Generation Air Transportation System, or NextGen. Among its many components was the goal of shifting from radar-based to satellite-based technology by 2025. “This included important applications in approach control to airports (for example, curved merging approaches rather than stacking up in a line in the sky) and moving from towers using paper flight data strips to electronic ones,” Strong said. “The technologies were rolled out to a limited number of airports.”
A September report by the Department of Transportation’s Office of Inspector General said that the FAA had spent about $15 billion by the end of 2024 to deliver “new capabilities and benefits,” but ultimately fell short, concluding that “FAA’s efforts have not delivered the vision of a transformed and modernized air traffic system.”
“So the FAA has a long history of problems that extended from the George W. Bush administration, through Obama, Trump I, and Biden,” Strong said.
But technology, alone, is only one part of the picture, Sherry said. “The way to improve the system is to better manage the flow,” he said.
The flow of air traffic can be managed by changing the number or direction of runways at an airport or by adjusting the flight paths into the airport.
“For sure, you don’t want the sector controller using an old system, but, at the end of the day, that’s not where the bottlenecks are,” Sherry said, the bottlenecks are in the flow.
There are other factors, too, such as staffing shortages. While the number of flights has increased by about 10% over the last decade, the number of air traffic controllers has decreased by about 6%, according to a December report from the Government Accountability Office.
As we said, in May, the Trump administration issued a proposal “to build a brand new, state-of-the-art air traffic control system that will be the envy of the world,” according to a press release. The initial contract for that project was awarded in December to Peraton, a security and technology company.
The One Big Beautiful Bill Act that passed in July provided $12.5 billion for the project, which Secretary of Transportation Sean Duffy said is expected to total $31.5 billion and be finished by the end of 2028.
But experts have characterized the plan as more of an extension of NextGen than a completely unique plan to overhaul the air traffic control system.
“FAA will continue to deploy NextGen systems beyond 2025 and other key capabilities beyond 2030,” the GAO said in its September report reviewing its oversight of the NextGen program. “Furthermore, the Secretary of Transportation recently announced a $31.5 billion plan for FAA to build the Brand New Air Traffic Control System, a state-of-the-art system that will replace core infrastructure including automation, communication, surveillance, and facilities. These plans include accelerating deployment of several key NextGen programs to be complete by 2028.”
A list of projects for the initial contract issued by the FAA on Dec. 4 shows technology and hardware upgrades, such as new radios, some updated radar systems, and additional weather-related systems.
“Everything listed there is some equipment located at some facility in the air traffic control system,” Sherry said. “It’s not to say those things aren’t necessary, but it’s a bottom up approach — it looks like a list of things people have wanted.”
The existing equipment has some limitations — some of it is old and unreliable, he said. “So, all of that needs to be upgraded. And that’s what’s been released by the FAA. But it would be nice to take this opportunity to update the principles, not just the technology,” Sherry said.
Strong told us something similar. “What is being promoted now [is] quite a step change and well beyond the incrementalism in recent years. That said, I think it mainly is modernization of facilities and equipment, but not a fundamental rethinking of how the ATC system might operate, how it should be governed, operated, and funded,” he said. “I do think the current Trump admin proposal will be a major improvement – if it can be completed on time and on budget. But both the timeline and past experience makes me withhold judgment at this point.”
The Brand New Air Traffic Control System, or BNACTS, is going to finish off what NextGen never got to do, Sherry said.
For example, as described in the GAO report, the NextGen plan had envisioned installing a tool that would help to more efficiently move planes between gates and runways called a Terminal Flight Data Manager program, or TFDM, at 89 airports. The first one was deployed in 2025, but the plan reduced the total number of airports to 49 and delayed the rollout for those airports to 2030.
“However, as part of the Brand New Air Traffic Control System, FAA now plans to deploy TFDM to all 89 planned sites,” the report said, and, indeed, the TFDM system is included in the BNACTS plan.
“It’s an extension of NextGen,” Sherry concluded of BNACTS.
The 2021 Infrastructure Investment and Jobs Act provided $5 billion specifically for air traffic control improvements — $1 billion per year for five years.
Of the funding for air traffic control, $3 billion was spent by the end of fiscal year 2024, Strong said. About a third of that was spent on tower replacements and upgrades, largely in secondary places, such as Grand Junction, Colorado; Missoula, Montana; Wheeling, West Virginia.
“The remaining $1.9b was allocated across updating power and communications systems (such as the one at Newark and Philadelphia which caused all the problems in 2024 and earlier this year), navigation/weather/tracking equipment, tower approach and departure facilities, long range radar and enroute flight centers,” Strong said.
Another $284 million was used to fund a surge in controller hiring to begin to address the shortfall in the number of controllers, Strong said. “This was an important down payment on staffing shortages.”
Katie Thomson, who served as deputy administrator for the FAA during the Biden administration, noted the $5 billion included in the Infrastructure Investment and Jobs Act, too, when we asked her about the competing claims from Trump and Buttigieg.
She also noted a 15-year contract that was given to Verizon in 2023 to provide faster and more secure communications called the FAA Enterprise Network Services Program, or FENS, and the budget proposal for fiscal year 2025 for facility replacement and modernization, or FRRM, that would have spent $9 billion over five years to replace some facilities and modernize radar systems, although Congress didn’t allocate those funds during the Biden administration.
“The current efforts to build a ‘Brand New Air Traffic Control System’ are derivative of the FENS contract and the FRRM proposal – both initiated by the Biden Administration,” Thomson told us in an email.
We reached out to Buttigieg to ask what he was referring to when he said that Trump was “passing off as his idea” a Biden era plan, but we didn’t hear back.
“My assessment is that the failure of [air traffic control] modernization predates the Biden administration,” Strong said. “However, the funding during the Biden administration was mostly carrying on with plans that were inadequate in both scope and funding. The Infrastructure bill provided very little funding for [air traffic control] (in relative terms) and much of it was to deal with immediate problems (staffing, equipment breakdowns, etc.)”
One of Trump’s frequently repeated claims is about the use of copper wire, as compared to fiber optic cable, for air traffic communications systems.
For example, Trump said while visiting Qatar in May, “They wasted billions of dollars on trying to hook up air systems to copper and they tried to hook up copper to glass.”
The White House didn’t respond to specific questions about several of the president’s claims, but a spokesperson did point to the highly publicized issue at the Newark Liberty International Airport this spring, when there were at least three outages of air traffic communications equipment for up to 90 seconds. Some lawmakers said outages were due to a “fried” copper wire.
“The FAA has multiple communications systems including copper wire and fiber, as well as some wireless,” Strong told us, and those systems are patched into one another.
Sherry considers references to copper wire as a euphemism for old infrastructure, like a landline phone. Part of the NextGen plan was to upgrade air traffic control systems to optical cable, which has better speed, accuracy and reliability, he said.
We asked the FAA how much of the older wire had been replaced across the system, but we didn’t get a response.
Echoing a longstanding anti-vaccine trope, President Donald Trump falsely claimed that the American vaccine schedule “long required” babies to get “far more” vaccines than are given in “any other” country, and he directed health officials to better “align” practices with those of other countries. The recommended schedule in the U.S. is quite similar to that of other high-income nations, and it isn’t a federal mandate.
Moreover, there are important country-specific differences, such as health care systems, that can explain why vaccine schedules differ around the world. There is no evidence that the existing U.S. vaccine schedule is harmful to children.
Trump’s directive came in a Dec. 5 memo, which told the director of the Centers for Disease Control and Prevention to “review best practices from peer, developed countries” and consider updating the childhood vaccine schedule to “align” it with countries that give fewer vaccinations.
Indeed, multiple news outlets have recently reported that the Department of Health and Human Services is considering changing the U.S. vaccine schedule to match or nearly match that of Denmark, which recommends vaccination against an unusually low number of diseases. Some outlets reported that a canceled Dec. 19 press conference was set to announce this news. (An HHS spokesperson told reporters that the accounts about the topic of the press conference and planned changes were “pure speculation.”)
Update, Jan. 6, 2026: On Jan. 5, Acting Director of the Centers for Disease Control and Prevention Jim O’Neill signed a memorandum that reduced the number of diseases targeted in the childhood vaccine schedule for all children to 11, just one more than Denmark’s schedule. A year ago, the U.S. childhood vaccine schedule had universal recommendations targeting 17 diseases. Officials justified the decision — which circumvented the normal process for changing vaccine recommendations — by comparing the U.S. vaccine schedule to those of other nations.
Explaining the rationale for his directive in a Dec. 5 post on Truth Social, Trump exaggerated the number of vaccines given to American babies.
“The American Childhood Vaccine Schedule long required 72 ‘jabs,’ for perfectly healthy babies, far more than any other Country in the World, and far more than is necessary,” Trump said in the post. In the past, he has incorrectly claimed that babies get “80 different vaccines” all at once.
It is difficult to give a single number for how many shots children receive in the U.S., but babies do not get 72 vaccines. As of early 2025, a child by age 2 was routinely recommended to get around 30 vaccine doses that protected against 15 diseases. Many of the doses are given in combination vaccines, however, so the number of shots given is typically lower. By age 18, the total number of doses could reach into the 70s, but only if including seasonal influenza and COVID-19 vaccines for every year.
“Getting to an exact number is difficult, given the flexibility in how vaccine doses are administered, but by any measure, any number that reaches the 50s or 60s, let alone 70s, invariably includes annual influenza vaccines and COVID-19 vaccines from birth through age 18,” Jason Schwartz, a professor at the Yale School of Public Health with expertise in vaccine policy, told us.
The CDC recommends, but doesn’t require, vaccines on the schedule, which influences what insurance policies and federal vaccination programs will cover. Vaccine mandates for school or day-care attendance are set by states, and there are exemptions.
Trump’s claim is similar to one made in a Food and Drug Administration presentation given earlier on Dec. 5 during the CDC’s Advisory Committee on Immunization Practices’ meeting. Dr. Tracy Beth Høeg, the new chief of the FDA’s drug division and ex-officio ACIP member for the agency, said that as of early 2025, the U.S. was “really an international outlier in giving 72 doses of vaccines.” She contrasted the total with those of four other countries, including Denmark. Høeg’s counting choices, however, served to inflate U.S. numbers while minimizing those of other nations.
Since June, when HHS Secretary Robert F. Kennedy Jr. dismissed all the committee members and installed new ones, ACIP has departed from its normal evidence-based processes and weakened some vaccine recommendations.
Exaggerations notwithstanding, these claims assume that recommending more vaccines for children is a bad thing. In fact, vaccines were added over time to the U.S schedule through an evidence-based process, with the goal of protecting children against more diseases. And even as the schedule has grown, the total number of antigens — the proteins or sugars in vaccines that stimulate an immune response — remains lower today than a century ago.
“More vaccines is actually a good thing,” Dr. Sean O’Leary, a pediatric infectious diseases specialist at the University of Colorado Anschutz, told us, adding that vaccines on the schedule are studied for safety and effectiveness and “the actual number is not an issue.” O’Leary is chair of the American Academy of Pediatrics Committee on Infectious Diseases. The AAP is a nonprofit membership group representing pediatricians. This year, for the first time in decades, the AAP issued different vaccine recommendations than the CDC.
Høeg and Trump are not alone in giving high estimates of U.S. childhood vaccine totals. This is a common strategy long used by anti-vaccine advocates to imply that the U.S. vaccine schedule has grown at an alarming pace.
It is challenging to come up with a single number of vaccines universally recommended in each country, as children can get protection against the same diseases using different combinations of vaccines. The reality, however, is that countries’ vaccine schedules are fairly similar, which becomes more apparent when looking at the number of diseases targeted.
“The core set of diseases for which vaccines are used is very similar across high income countries,” Dr. Andrew Pollard, a pediatrician and director of the Oxford Vaccine Group at the University of Oxford, told us. “However, there is some variation based on differences in disease burden and the way in which the health system works.” For example, he said, some countries place more emphasis on cost-effectiveness than others.
As of early 2025, the U.S. had universal recommendations targeting 17 diseases in childhood and adolescence, including the 15 targeted in early childhood plus meningococcal and human papillomavirus vaccines recommended at older ages. Again, there is some ambiguity in counting how many diseases a vaccine schedule targets and in deciding which nations are “peer, developed countries.” But looking at data on the 31 nations that are both members of the Organization for Economic Cooperation and Development and classified by the International Monetary Fund as “advanced economies,” 17 is just a few more diseases targeted than the median of 14, according to our analysis. (We did not count infant immunizations with antibody products that protect against respiratory syncytial virus, or RSV, in our totals, as these are not vaccines. Countries vary in whether they have adopted maternal vaccination, infant immunization or — as in the case of the U.S. — flexibility in choosing either.)
In recent months, the U.S. has walked back universal recommendations for hepatitis B and COVID-19 vaccination for children. That brings the current U.S. total down to 15.
Trump’s memo and Høeg’s presentation did include comparisons of the number of diseases targeted by Japan, Denmark, Germany and, in Høeg’s case, the U.K. But they did not place these countries in a larger context of high-income nations.
“The U.S. has a robust set of vaccine recommendations, and that reflects the priority on using the tools that are available to prevent illness and death, particularly in children, but the differences between the U.S. and peer countries have been overstated,” Schwartz said.
“The real outlier in this conversation appears to be Denmark,” he added.
Denmark is one of just three OECD advanced economy nations to not universally recommend the hepatitis B vaccine. It is also in the minority in not recommending vaccines against rotavirus, meningococcal disease or chickenpox. The U.S., on the other hand, is one of the few high-income nations to recommend vaccination against hepatitis A or to continue recommending universal COVID-19 vaccination until recently.
There is some truth to the idea that the U.S. vaccine schedule recommends a relatively high number of doses. However, anti-vaccine advocates often justify dramatically high numbers of doses compared with other countries by using misleading methods of counting.
In reality, a person could complete the U.S. childhood and adolescent vaccine schedule as of early 2025 while receiving less than two dozen shots and oral vaccines, not including flu and COVID-19 vaccines.
Høeg acknowledged during her presentation that in arriving at a count of 72 doses, she had counted “the yearly influenza vaccine,” but she omitted context on other countries’ flu vaccine recommendations.
The U.S. does stand out somewhat in having a longstanding universal recommendation for seasonal flu shots, including for children age 6 months and older. The universal childhood flu vaccine recommendations were progressively adopted in the U.S. in the 2000s, expanding to cover kids up through age 18 before the 2008-2009 flu season.
However, the U.S. is not alone in recommending childhood flu vaccination. In Europe, for example, flu vaccination recommendations for children have become more common in recent years, according to a November 2025 report from the European Center for Disease Prevention and Control. During last year’s flu season, six of the 30 European countries analyzed had universal recommendations throughout childhood beginning at 6 months, and another 13 countries had universal recommendations for certain age groups. (The remaining countries — including Denmark and Germany — recommended the vaccines to children with certain risk factors.) In our analysis of OECD countries with advanced economies, 22 out of 31 nations recommended universal flu vaccination for at least some portion of childhood.
In her dose comparisons, Høeg did not highlight vaccine recommendations from any countries that universally recommend these annual vaccines throughout childhood. Examples of these countries include Austria, New Zealand and Canada.
In her dose count for the U.K., which she reported as 17, Høeg appeared to omit annual flu vaccines, which are recommended every year from age 2 until around age 15.
The conclusion that the U.S. vaccine schedule ever included 72 doses also relies on counting yearly COVID-19 vaccines through age 18. But this relies on a counterfactual scenario in which annual shots were recommended for kids over an entire childhood. In the end, the annual doses were universally recommended starting at age 6 months for just over three years.
The U.S. was relatively slow among nations to drop its universal recommendation for COVID-19 vaccination in children. But even before Kennedy reconstituted the CDC’s vaccine advisory committee, the group had been moving toward a risk- and age-based approach to COVID-19 vaccinations.
This year, the AAP adopted recommendations similar to what the former advisory committee had been considering, urging kids under 2 to get vaccinated but backing away from a universal recommendation for all children. Under Kennedy, the CDC decided to recommend COVID-19 vaccination for all Americans 6 months and older under shared clinical decision-making. This means that people can discuss whether they need the vaccines with health care providers and get coverage for them if desired, but the vaccines are no longer universally advised.
Another way anti-vaccine advocates inflate U.S. dose counts is by individually counting vaccines commonly given as a combination shot. The relative flexibility of the U.S. schedule and the availability of a variety of vaccines allows people to construct theoretical scenarios involving high numbers of doses.
In arriving at her count of 72 vaccine doses in the U.S. schedule, Høeg said on a slide in her ACIP presentation that she had counted vaccines against polio, hepatitis B, Haemophilus influenzae type b (Hib), and diphtheria, tetanus, and pertussis (DTaP) separately. These individual vaccines are available, but most babies get some doses in combination shots, experts told us.
“It would be highly unusual, if not unheard of, for a child to receive each vaccine separately,” Dr. Michelle Fiscus, a pediatrician and chief medical officer of the Association of Immunization Managers, told us, referring to the combination vaccines.
Meanwhile, countries like Denmark and the U.K. have less flexible schedules that include specific combination shots. In calculating her low totals of 11 and 17 doses in these countries, respectively, Høeg appeared to count combination shots as only single doses, despite not always doing this in the U.S. tally.
She justified this by saying that “part of the difference” between the U.S. and other countries is that the U.S. can give individual vaccines, “whereas Europe tends to give combination vaccines in those circumstances.”
The FDA did not reply to a request for more information on how Høeg calculated her figures.
Trump’s directive to consider emulating vaccine schedules from other nations also glosses over major differences between countries that shape their recommendations.
Countries are, of course, more likely to recommend vaccinations against diseases if they are common in the area. For example, the U.S. does not vaccinate routinely against “tuberculosis, typhoid, yellow fever, malaria, meningococcal disease (for infants), or dengue, while these are routinely recommended in other countries,” an AAP fact sheet said.
Other factors include those related to a country’s health system, such as availability of specific vaccines or combination vaccines, the timing of routine health visits and cost-effectiveness analyses, the fact sheet said.
“We’re the most well resourced country in the world, and so sometimes we adopt things earlier, because some other countries are more cost-conscious,” O’Leary said. “But it’s not that they’re concerned about safety issues.”
In some cases, the difference between the U.S. and other countries is not in whether vaccination is recommended at all, but in whether it is recommended universally.
For example, as we have previously written, Denmark takes a risk-based approach to hepatitis B vaccination that relies on testing pregnant women for the disease and tracking at-risk babies. ACIP members cited policies in other countries to justify recently changing the U.S. approach to a risk-based one, despite objections from experts who said that the U.S. had an inferior rate of screening and follow-up.
“What we know, at least in the U.S., is that risk-based approaches don’t work,” O’Leary said. “That’s been shown over and over again.” These risk-based approaches might work better in countries with universal health care systems and electronic health records that track people across their entire course of life, he said.
Høeg did mention cost and other practical considerations as a factor on some slides, but she also held up Denmark’s evidence-based practices as an example while sharing safety concerns about vaccines.
Denmark has a “research culture where they really rely on randomized control trials, extensive documentation about the decision-making, about which vaccines they do and don’t recommend,” she said. But experts rejected the implication that the U.S. recommendations vary from those in Denmark due to differences in transparency and rigor of decision-making.
“Certainly in the U.S., we have decades of evidence of careful deliberation regarding how to use our vaccines optimally, very transparent advisory committee processes that have functioned for decades, the very active vaccine surveillance programs that have existed for decades designed to respond to rare adverse events,” Schwartz said.
“Their decision-making is not any higher quality than ours,” O’Leary said of Denmark. It is only recently, with the appointment of Kennedy and the new ACIP panel, that the vaccine decision-making process has departed from the “normal process that has been built over decades in the U.S.,” he added.
“We consider the vaccines that are used in the US but not in Denmark to be safe and effective,” Anders Hviid, who studies vaccination and epidemiology at the Statens Serum Institut in Denmark, told us in an email. “Every country is different, and every country’s national responsible authorities must make their own decisions based on a careful evaluation of national epidemiology, cost, logistics, ethics etc.”
Trump also was incorrect in claiming that the vaccine schedule “required” 72 shots for “babies.” There are no national vaccine mandates in the U.S., unlike in some other countries, including in Europe, although the U.S. does rely on school vaccine requirements that are set by states.
The vaccine schedule is made up of CDC recommendations on how vaccines should be used at the population level, guided by the recommendations of ACIP. “While the ACIP recommendations are closely watched, they’re influential, they’re important in how we think and talk about vaccines in the United States, nothing ACIP does directly connects to whether a vaccine is required for a particular child,” Schwartz said.
States set vaccine requirements children must meet to attend schools and licensed day care, he said. Discussions about these requirements “often begin with ACIP recommendations as a starting point for whether to consider a particular vaccine requirement, but those decisions by no means derive automatically from ACIP’s action,” he added.
For example, while a few states recommend yearly flu shots for young children in day care, states do not recommend annual flu shots for school-age children, even though these are on the vaccine schedule. No states currently require COVID-19 vaccines in schools.
“The U.S. has certainly featured vaccine requirements more prominently than many of our peer countries,” Schwartz said, referring to the state-level school requirements favored in the U.S. to reach high vaccination rates. But that “has been changing in recent years, precisely because of declining vaccination rates, in western Europe in particular,” he added.
For example, Germany — highlighted as a peer nation by Trump and Høeg — in 2020 passed the Measles Protection Act, a national measles vaccine requirement for people being cared for in certain communal facilities, such as schools or day care, as well as those working in these and other facilities, such as hospitals. Since 2018, France has required childhood vaccination against a total of 11 diseases, an increase from a previous requirement for just the DTaP vaccine. The law is also enforced by barring children who have not met the requirements from attending schools or other settings where children gather.
One 2024 analysis of vaccination policy in Europe and the U.S. found that 12 out of 32 countries had at least one nationally required vaccine. A 2020 paper analyzing mandatory vaccination policies in Europe found that mandates were associated with a greater rate of people getting vaccinated and a lower rate of measles in countries that adopted them.
Correction, Dec. 23: In counting the number of OECD countries with advanced economies that recommended universal flu vaccination for at least some portion of childhood, we inadvertently included the wrong figure. The correct number is 22, not 21.
