In the midst of the country’s worst measles outbreak in 25 years, President Trump made an abrupt about-face on vaccinations.

Before becoming president, he had spread vaccination fears by peddling anti-vaccine tropes on Twitter and meeting with anti-vaccine conspiracists. When faced with the growing measles outbreak, the president seems to have changed his tune and now urges Americans to “get their shots.” Behind the scenes, though, his administration’s efforts could undermine public health efforts to ensure that children and adults get the vaccinations they need to prevent illness.

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