Washingtonium, August X, MMXXVI — Some executive orders move armies. Some move markets. Some move entire federal agencies.
And then there are executive orders capable of making the family calendar look at its owner and quietly whisper:
“We’re going to need more Tuesdays.”
His Vaccinational Majesty Donaldus J. Trumpius Caesar Maximus, Imperator of America Magna, Protector of Parental Authority, Supreme Auditor of Gold Standards and Eternal Commander of Documents Bearing Very Important Signatures, has issued a new imperial proclamation concerning childhood vaccines.
Not merely recommendations.
Not ordinary recommendations.
Certainly not boring recommendations.
These are the:
GOLD STANDARD CHILDHOOD VACCINE RECOMMENDATIONS.
Because in the Empire of Trumpius, even a vaccination schedule must sound like something available with marble countertops, complimentary valet parking and a magnificent view of the golf course.
The Great Imperial Vaccine Audit
The proclamation begins with a scientific assessment conducted by the Department of Health and Human Services — henceforth known throughout the imperial provinces as the Ministerium Sanitatis Americanum.
According to the order, the assessment compared American childhood vaccine recommendations with those of other developed countries and concluded that the United States recommends more childhood vaccines than any peer nation, including considerably more doses than some European countries.
Trumpius Caesar surveyed these findings from the Golden Throne.
Many vaccines.
Many doses.
Many appointments.
Possibly too many little stickers saying, “I was brave today.”
And so the Emperor apparently reached the most Trumpian conclusion imaginable:
America requires a better system.
A beautiful system.
A scientific system.
A system so gold that ordinary gold might require sunglasses.
The order also points to another difference: many peer countries maintain high childhood vaccination rates largely through public trust and education, while American States establish vaccination requirements that can affect school attendance.
For Trumpius, this could mean only one thing:
The imperial vaccine scroll required reorganization.
Category I: The Universal Vaccine Legion
The new Gold Standard divides childhood immunizations into three grand imperial categories.
First comes the mighty Legio Vaccinata Prima — immunizations recommended for all children.
Marching beneath its banners are vaccines against measles, mumps, rubella, diphtheria, tetanus, pertussis, polio, Haemophilus influenzae type B, pneumococcal disease, HPV and varicella.
A formidable medical legion.
At its head marches Measlius Defeatus, accompanied by Mumpsius Minor, Rubellia Maxima, Tetanus Ferreus and the ancient enemy Poliomyelitus Terribilis.
These are the core troops of the Trumpian vaccine empire.
No tiny helmets are required.
Category II: The Special Vaccine Cohort
Next comes the Cohors Vaccinata Specialis, intended for certain higher-risk groups or populations.
The imperial scroll places RSV monoclonal antibodies, hepatitis A, hepatitis B, meningococcal B, meningococcal ACWY and dengue in this category.
These are not ordered to march universally across every pediatric office from Florida to Alaska.
Instead, their role depends more heavily on circumstances, risk and population.
Nuance!
Inside the Empire!
Several imperial scribes reportedly dropped their quills.
Category III: The Great Parent-Doctor Council
The third category may be the most philosophically Trumpian of them all:
shared clinical decision-making.
The order places hepatitis A, hepatitis B, rotavirus, meningococcal disease, influenza and COVID-19 within this category.
Here the physician and parents are supposed to discuss the situation and determine the appropriate course.
The palace has unofficially renamed this procedure:
Consilium Parentum Medicorum Maximum.
Or, translated from Imperial Trumpian into modern American:
“Talk to your doctor. A very good doctor. Maybe a fantastic doctor. Make a decision.”
Parental choice becomes one of the central pillars of the entire imperial architecture.
But then Trumpius reaches the part where calendars begin trembling.
One MMR Shot? Caesar Has Another Idea
The order recognizes that the combined measles, mumps and rubella vaccine should eventually be administered as three separate single-disease shots once such products become domestically available.
One combination becomes three individual products.
And the proclamation goes further.
To the maximum extent feasible, childhood immunizations should be administered at separate medical visits.
Somewhere in suburban America, a family calendar just burst into flames.
Monday:
Measles.
Tuesday:
Mumps.
Wednesday:
Rubella.
Thursday:
Parent searches desperately for another parking space at the pediatrician.
Friday:
Child demands compensation in ice cream.
What once was a vaccination appointment could become the Imperial Pediatric Tour MMXXVI.
Coming soon to a waiting room near you.
Featuring crayons, magazines from 2023 and the mysterious aquarium containing one fish nobody has seen move since February.
Ninety Days for the Imperial Vaccine Scholars
Trumpius Caesar next summons the health bureaucracy.
Through the HHS Task Force on Safer Childhood Vaccines, the Health Secretary is instructed to develop plans within 90 days covering several major areas.
The administration wants to explore single-vaccine alternatives beginning with MMR while maintaining access to combination vaccines.
It wants the timing and sequencing of childhood vaccines examined.
It wants research into alternative adjuvants to aluminum.
It wants comparative safety and efficacy studies.
It wants continuing assessment of vaccine risk-benefit profiles using American and international data.
And it wants better safety monitoring, transparency and research.
In short:
More research.
More evaluation.
More monitoring.
More reports.
And eventually, inevitably, more binders.
Beautiful binders.
Perhaps the finest binders Washington has ever seen.
For no imperial scientific initiative is truly complete until somebody carries a 240-page document through three security checkpoints and places it upon the desk of an Assistant Deputy Undersecretary for Extremely Important Things.
The new motto of the palace:
In Gold Standard Scientia We Trust.
Enter the Imperial Department of Justice
But Trumpius Caesar is not content merely to reorganize medical recommendations.
Now comes law.
The Attorney General is instructed to take appropriate measures regarding meritorious legal challenges to State laws that may conflict with constitutional or Federal statutory obligations involving parental authority, religious freedom, disability accommodations and equal protection.
The Departments of Justice, Education and Health and Human Services are likewise instructed to ensure that contractors and recipients of Federal grants comply with applicable Federal obligations, including religious and medical exemptions where Federal law requires them.
Thus the childhood vaccination schedule enters one of America's oldest and most magnificent traditions:
Litigation.
Medicine meets parental authority.
Parental authority meets religious liberty.
Religious liberty meets State law.
State law meets Federal law.
Federal law meets constitutional law.
And somewhere in Washingtonium, a constitutional attorney orders another coffee.
A Message to the Governors
States and territories are also advised to review the new Gold Standard recommendations and consider whether their vaccination laws and regulations — including requirements connected to school enrollment and attendance — should be updated.
This is not quite Caesar marching a legion across the Rubicon.
It is more like Caesar mailing the governors a very large envelope.
The imperial translation reads:
“You don't necessarily have to change everything. But His Majesty would strongly appreciate your careful consideration of this extremely long document.”
Governors across America Magna know what happens next.
Perhaps a review.
Perhaps a lawsuit.
Perhaps a press conference.
Perhaps another executive order.
Possibly all four before lunch.
The Gold Standard That Can Be Re-Gilded
Perhaps the most fascinating feature of the Trumpian Gold Standard is that it is not necessarily carved permanently into marble.
The recommendations are supposed to be routinely reassessed according to future findings from the HHS Task Force on Safer Childhood Vaccines.
Thus America receives something truly majestic:
A renewable Gold Standard.
Gold today.
Reviewed tomorrow.
Potentially re-gilded on Thursday.
This is the essence of imperial administration under Trumpius Caesar:
First establish the Gold Standard.
Then investigate the Gold Standard.
Then improve the Gold Standard.
Then perhaps announce the New and Even More Golden Gold Standard.
Imperial progress!
And Who Pays for the Scroll?
Naturally, no American executive order would be complete without the traditional final provisions.
Existing statutory authorities remain intact.
Implementation must remain consistent with applicable law.
Everything remains subject to available appropriations.
And the order does not automatically create a judicially enforceable right or benefit against the United States or its officials.
The Empire giveth the Gold Standard.
The lawyers giveth the disclaimers.
But one crucial question remains:
Who pays to publish the proclamation?
The Department of Health and Human Services.
Of course.
Because even in the mighty Empire of Trumpius, someone eventually receives the printing bill.
And thus concludes the newest proclamation of Donaldus J. Trumpius Caesar Maximus: a sweeping imperial rearrangement featuring three vaccine categories, greater emphasis on parental choice, new research mandates, separate-vaccine ambitions, Federal-State legal questions and enough potential pediatric appointments to make Google Calendar request hazard pay.
Trumpius raises the Golden Presidential Quill above the assembled senators, physicians, lawyers, bureaucrats and exhausted parents.
And from the marble halls of the White Palatium comes the imperial declaration:
“One vaccine. One appointment. Another vaccine. Another appointment. Tremendous appointments. The greatest appointments anyone has ever scheduled.”
Ave Trumpius. Ave Vaccina. Et Calendarium Miserere Nobis.
