Pediatricians describe vaccine reimbursement as inadequate
Paxton announced in January that he would investigate an alleged conspiracy between pediatricians, vaccine makers and insurance companies, alleging that the pharmaceutical and insurance industries had “illegally incentivized” doctors to administer vaccines and had attempted to “bribe” medical providers, The Guardian reported. The Republican Senate candidate linked his efforts to a campaign against vaccines from President Donald Trump and Health and Human Services Secretary Robert F Kennedy Jr., and directly referenced the Make America Healthy Again movement in his announcement. Trump endorsed Paxton’s Senate bid in May.
In August, Paxton opened a separate investigation into the American Academy of Pediatrics, accusing the organization of potentially recommending vaccines for financial gain. That investigation referenced a lawsuit the AAP had filed earlier in the year to halt sweeping changes to the childhood immunization schedule, The Guardian reported.
Investigators in Paxton’s consumer protection division have asked the pediatrician now under investigation for details on every “reward, financial benefit, bonus, discount, return, rebate or other consideration” received from vaccine makers, The Guardian reported, citing the New York Times. The pediatrician has spent thousands of dollars in legal fees responding. The Guardian reported that all pediatricians could be at risk of investigations, making the future of practicing pediatrics in Texas hazy.
Pediatricians and public health officials told the paper the financial-incentive characterization does not match what they see in practice. “Pediatricians are one of the lowest-paid medical specialties and ‘barely break even’ on vaccines,” Marjan Linnell, a pediatrician and president-elect of the Texas Pediatric Society, told The Guardian. Katherine Wells, director of Lubbock Public Health, said her department receives as little as $6 for giving a vaccine and about $13 total to cover the costs of administration. “That does not cover the time of a nurse to talk to the parents, review the shot record, draw up the vaccine, give the injection, provide the education,” Wells said. “It’s way more than six bucks for me to do that in a health department, and I’m a low-cost, low-overhead entity. I’m taking a loss every time I give a vaccine, but it’s the right thing to do.”
The Guardian noted that Kennedy, who oversees HHS, has personally made millions of dollars suing vaccine makers. He has earned at least $2.5 million in referrals for lawsuits related to vaccine side effects to the law firm Wisner Baum, according to The Guardian. Kennedy held a 10% contingency stake in a Gardasil vaccine lawsuit that reportedly settled for about $50 million in June. During his confirmation hearing, Sen. Elizabeth Warren, a Massachusetts Democrat, asked Kennedy about those potential conflicts and whether he would continue receiving money from lawsuits while overseeing and after leaving HHS. Kennedy initially said he would stop profiting from vaccine lawsuits, but he later filed an amended ethics disclosure saying he would give the money to one of his sons.
Kennedy has frequently criticized the American health care system, decrying what he says are doctors who make decisions based on a “financial bonus” and “hidden incentives that corrupt medical judgment,” according to a video he posted on X in August 2025. “Doctors are being paid to vaccinate, not evaluate,” Kennedy said in the video. “That’s not medicine. That’s coercion.” Children’s Health Defense, the organization Kennedy previously led, has reported doctors in Lubbock to the Texas medical board for treating measles patients and sued the AAP for racketeering on the same day Paxton announced his investigation of pediatricians, The Guardian reported.
A February survey cited by The Guardian found that both primary care doctors and the American Academy of Pediatrics enjoy high levels of public trust, with both ranked as more trustworthy than federal health agencies. A new Texas law has made it easier for parents to request school vaccine exemptions. The Guardian reported that 93.3% of Texas kindergarteners are fully vaccinated against measles, a decline the paper linked to growing exemption rates.
The Guardian cited vaccine expert Paul Offit of Children’s Hospital of Philadelphia, who said pediatricians remain broadly popular with the public. “Pediatricians are beloved,” Offit said. “People see them as nice people trying to do the right thing.” Offit added: “I just think this war on pediatricians is not a winner. Ken Paxton, I think, is desperate. He very well may lose to Talarico, and this is a stupid, desperate thing to do.”
Linnell warned that the threat of legal action could further shrink Texas’s already short supply of primary care physicians, with smaller practices potentially forced to choose between vaccinations and high legal and administrative fees. “Texas already has a shortage of primary care,” Linnell said. “If you’re going to be potentially threatened with a lawsuit that could close your business down, it’s yet another reason for people to not go into primary care.” She added: “If you have a fear that you’re going to have to spend a bunch of money — potentially stop your practice or really take a financial hit, having to defend a lawsuit — then it could be conceivable that you won’t be able to offer children vaccines.”
Making it more challenging for children to get vaccinated will increase the risk of vaccine-preventable diseases such as measles, Haemophilus influenzae type b, and others, Linnell said. These are diseases she had never seen before in her career and had hoped never to see — but they are now spreading throughout the country, even as the means of preventing them is being undermined, she added. “Threats like this just feed into this fear,” Linnell said.
The accusations of financial gain are particularly puzzling because vaccines are expensive and time-consuming to maintain and administer, Linnell said. Staff are trained in how to administer them; storage requires special freezers that cannot ever lose power. A couple of years ago, a five-day freeze left the bridge to Linnell’s clinic frozen and forced her to throw out every vaccine in the freezer. “All of those vaccines, our clinic had to pay out of pocket to replace,” Linnell said. With vaccination, “in some cases, we barely break even,” she said. “It’s not something we would do if we didn’t think they were so critically important and so safe.” She continued: “Vaccines are expensive, but they’re worth it. They are one of the best studied, safest things that we can do to keep kids in their communities, playing, going to school.”