Robert F. Kennedy Jr., secretary of health and human services, appointed eight new members of an expert panel that advises the federal government on immunization policy, including several vocal vaccine critics and one who identifies as an “anti-vaxxer.

Even so, Kennedy’s decision to fire all of the panel’s members and replace them is unprecedented. The HHS secretary wields broad authority to manage the panel as he sees fit under federal law.

“Out of pocket costs for vaccines become an issue where we could end up with a system where some people can afford vaccinating themselves and their families and others cannot,” DeMatteis said.