In his office at the American Academy of Pediatrics, CEO Mark Del Monte displays a photo of the Itasca-based association’s founding members at their first convention. For Del Monte, the 1930 image serves as a reminder of the rebellious spirit it took to create the academy at a time when centering children’s health was a radical notion: “They had seen a global pandemic. They had seen war zones and refugee crises. They saw all the problems with children — infectious diseases, no child labor laws of any kind — and decided the solution was to found a medical society where we have a child health mission. That’s an extraordinary act of courage. You have to take on some really big things.”

That has certainly been the case since Del Monte, a lawyer who has been with the AAP since 2005, took the helm in 2019. As the AAP pushes back against anti-vaccination policies and grapples with the issues surrounding gender-affirming treatment for trans children, Del Monte sat with Chicago to discuss the challenges brought by a second Trump administration that has turned health standards on their heads.

How would you characterize this stretch of time for the AAP since you became CEO?

These have been a consequential five years. We’ve had a global pandemic and multiple immigration crises at our southern border, the resurgence of vaccine-preventable diseases, and worsening of child health. In these moments when there’s real adversity for children and pressure on families, the role of the academy is most important. The first call I remember in the beginning of 2020 was: “A mother with COVID has just delivered. What do we do with the infant?” There’s no book on my shelf I can open and say, “Here’s what to do.” We had respiratory disease experts, we had neonatologists, we had everybody around the table to make the best judgment we could.

The AAP is one of six major medical organizations that filed a lawsuit in July against the Department of Health and Human Services and Secretary Robert F. Kennedy Jr. over what you called “unlawful, unilateral vaccine changes.” How did that coalition come together?

A number of us became increasingly concerned about the erosion of vaccine policy in the United States and began a conversation about what our options were. The views of the current secretary of health and human services have been well known to everyone for decades, and we don’t agree with the secretary’s position on vaccine safety and effectiveness. But we listened very carefully during the confirmation hearings to what he said. We hoped that we would not be in this position. We hoped that he would not emphasize anti-vaccine views as part of his role. When it became increasingly clear that was the direction the HHS was going, we had to sue. The firing of the Advisory Committee on Immunization Practices was a key pivot point for us. The rationale for the firing was that the existing committee members were somehow partisan or political and therefore suspect, and that’s false. This was a group of experts in pediatric infectious disease and epidemiology. These were not partisans, these were not political people, these were experts. They just didn’t agree [with Kennedy]. And that’s not a sufficient basis [for their removal].

I’ve read comments on social media where certain moms say things like “I can’t trust the AAP because of its positions on gender-affirming care.” (The AAP supports such care for minors — which includes psychotherapy, hormones, puberty-blocking drugs, and, rarely, surgery — but as public scrutiny and state-imposed restrictions have escalated, the organization has said it would undergo a systematic review of such treatments.) Does that skepticism shape your approach to policy?

The strain on that relationship, if there is one, is because it’s really hard to be a parent right now. Parents are inundated with social media and influencers telling them that they’re probably doing it wrong. Our strategy is to put as much good information out there as the bad information they’re seeing. “Should I be giving my child cod liver oil and high doses of vitamin A?” Parents can go to our website, or talk to their pediatrician, and see, no, that’s not true. It’s really important for people to believe that our recommendations are evidence-driven and science-based, and so we take great care to make sure that the things that we say, people can believe in. This is not a political organization. Despite the fact we’ve been talking about advocacy, we don’t engage in politics. We’re a 501(c)(3) nonprofit organization. We have no political arm. We have no political fundraising, unlike most medical societies. We work very carefully to stand on the science and stand on the policy. Now, not everybody agrees with that, and sometimes those disagreements are political.

What worries you most these days?

If you look at many indicators, the health of children is worsening. Half of children in the United States are growing up in poverty. That means half of children are getting their health care through Medicaid, which is at risk. Half of children need nutrition support, housing support, transportation support. The focus on protecting children from vaccine-preventable diseases and trying to protect the safety net for health insurance for children takes our focus off some of the larger things that we know that the secretary is also concerned about. We would like to be working on the mental health crisis for kids, to be working on children in poverty as leading-edge issues. We have concerns about plastics in children also. We are eager to work with the administration on school meals, to work with the FDA, with USDA, where most children get benefits through SNAP and WIC [supplemental nutrition programs]. At a minimum, we should be working together to make sure that the health of children is not going backwards, and exposing more children to vaccine-preventable illness is going backwards.

RFK Jr. has said that he’s not going to take vaccines away.

But he did. He already did. I mean, these are facts, right?

How do you foresee that a policy shift on vaccine recommendations would play out?

Fifty percent of kids have Medicaid, which means that 50 percent of kids are eligible for the Vaccines for Children program, the federally funded program that buys the vaccines. So if the ACIP recommendations change, that impacts directly the poorest children in the U.S. Private insurance may or may not follow those recommendations — there’s more ability to adjust in the private market. So if vaccine access declines, it will decline for the poorest kids first. That is a really unfortunate outcome, and not one that I think is intended by people who have concerns about vaccine policy.

The AAP has said that it will issue its own vaccine recommendations if ACIP’s change. How would that work?

The AAP has been making vaccine recommendations since 1938. We will continue to produce a schedule for families and for clinicians, no matter what happens to ACIP, so that the schedule is as authoritative in 2025 as it was in 1975 or 2000. And we need to make sure that insurance companies are there with us so that we don’t diminish access to those vaccines we recommend. So that’s what we’ll be working on. But we still need to have a robust and credible ACIP. Our aim is not to duplicate or separate from that, but if we need to do some stopgap measures while we’re trying to get the ACIP to resume its normal function, then we will.