INDIANAPOLIS — Donald Trump’s problem with abortion politics was never more apparent than it was here Monday, as he delivered brief virtual remarks to a Christian advocacy organization that wants to ban all abortions — and didn't mention the procedure once.

For all his efforts to avoid the issue and “make both sides happy,” as he has long promised, Trump still got hit by both sides — from Democrats for appearing at all, and from some of his own voters in the room for skirting a topic at the top of their agenda.

“He sounded more like a politician who wants to be elected,” said Rick Patrick, the senior pastor of First Baptist Church of Sylacauga, Alabama. “I voted for him and I plan to vote for him again, but he was not like the other speakers who were here talking about religious things.”

In a pre-taped video address just under two minutes long to the Danbury Institute, which calls abortion “child sacrifice,” Trump did not mention the word “abortion” at all, even though the group’s CEO praised Trump in an introduction for addressing, as president, what he called “the most important issue facing our country and the next generation of our children who are being slaughtered in the womb.”

Instead, Trump told the group, “You just can’t vote Democrat. They’re against religion. They’re against your religion in particular.”

The former president’s brief remarks to the Danbury Institute, on the sidelines of the annual meeting of the Southern Baptist Convention, served as the latest example of the tightrope Trump is walking on an issue where polls show he remains vulnerable. Before the address, for which he was billed as a speaker, Trump’s campaign privately cautioned that he would only give a pre-recorded welcome message lasting less than two minutes. His address drew only polite applause and garnered some criticism among anti-abortion Southern Baptist leaders in attendance.

“It’s disappointing because you would hope to have a Republican presidential candidate who speaks strongly that life begins at conception,” said Kevin McClure, an attendee from a Baptist congregation in Louisville who said Florida Gov. Ron DeSantis, whom he backed in the Republican presidential primary, was a better opponent of abortion rights.

Trump’s stated position on abortion — that the issue should be left to the states in the post-Roe era — is in conflict with the hardline position of the Danbury Institute. It is a major liability for him, even though he has taken credit for appointing the Supreme Court justices necessary to overturn Roe.

“The president is not dumb, and he recognizes just how lethal Dobbs was in the midterm elections. From a purely political perspective, I think both the president and even the Republican Party in general realize that where they have been is maybe not where people are, or at least the majority of Americans are,” said Matthew Bartlett, a Republican strategist and former Trump administration appointee.

But Trump also “cannot look like [he is] abandoning the religious right,” Bartlett said. And so he needs to “negotiate with the religious right, show that he understands them.”

Nearly two years out from Dobbs, roughly two-thirds of Americans continue to disapprove of the decision that felled federal abortion protections, according to a mid-April CNN/SSRS poll. And it remains a major issue for suburban women, a key voting bloc Trump has struggled with, according to a spring Wall Street Journal poll of seven swing states.

On the other hand, Trump may have found some middle ground with his stated position view that abortion rights should be left to states. Half of voters in a POLITICO-Morning Consult poll conducted after Trump cemented that stance in early April said they support states making their own laws about abortion access, compared to just 35 percent who do not.

On Monday, Trump’s video remarks came after nearly an hour of discussion earlier in the event about where the anti-abortion movement should be focusing in the post-Roe era — including restricting abortion pills and criminalizing women who receive abortions. Those policy measures would further curtail access to a procedure that is banned in almost all cases in more than a third of the U.S.

A Trump campaign spokesperson previously defended Trump’s appearance at the Danbury Institute, saying he “is committed to addressing groups with diverse opinions on all of the issues.”

But it came at a cost. President Joe Biden's campaign blasted Trump as a politician who “loves campaigning with abortion ban extremists.” And the Indiana Democratic Party joined in Monday morning, accusing Trump of “doing the bidding of the most extreme anti-choice groups in the country.”

Meanwhile, the former president disappointed many anti-abortion advocates still stung by his declining in April to endorse a national limit on abortion, saying that issue should be left up to state lawmakers and voters.

“We want to see abortion gone because it is a human rights issue,” said Tyler Murphy, an associate pastor at Southside Baptist Church in Fulton, Missouri, who supports a national abortion ban. “The federal government needs to protect its people.”

During an abortion-focused panel, Tom Ascol, senior pastor of Grace Baptist Church in Cape Coral, Florida, criticized anti-abortion groups for not taking bold enough positions on abortion since the fall of Roe. He and other speakers lamented the widespread accessibility of abortion pills, which have allowed people who live in states where the procedure is banned to terminate their pregnancies, and said that conservatives need to band together to work toward the complete elimination of abortion.

“Some of the pro-life organizations said, ‘Look, we've abolished abortion in America.’ No, we have not,” Ascol said.

And abortion was not the only issue on the religious leaders’ minds as was evident throughout the convention’s early proceedings. Prominent evangelical leader Al Mohler, president of the Southern Baptist Theological Seminary, said that Christians have before them a “bigger task than ever before” as he touted a resolution that is being put forward at the Southern Baptists’ annual meeting voicing opposition to in vitro fertilization as typically practiced in the U.S.

“We're about to find out how pro-life the pro-life movement is,” Mohler said.

Donald Trump, former Covid-19 vaccine booster, is now the nation’s most high-profile critic of immunization mandates.

The former president has on the campaign trail promised to strip funding from schools with vaccine requirements and lambasted independent candidate Robert F. Kennedy Jr. as a “fake” anti-vaxxer, while obscuring his role in speeding the development of the Covid shot when he was president during the pandemic.

Trump's new anti-vaccine persona could have far-reaching consequences if he's elected to a second stint as president with far-reaching administrative powers. Public health experts say a White House opposed to immunization mandates could potentially cause upticks in cases of measles, polio and other vaccine-preventable diseases, or hamper efforts to fight a future pandemic.

The CDC could pare back the number of vaccines it recommends children receive or eliminate those recommendations entirely. The CDC could change the paperwork required to be shared with parents to make vaccines sound less safe than they are. Or the FDA could increase the number of years of safety testing required for new vaccines and impose other onerous requirements for vaccines to be approved in the U.S.

Trump also could, as a thank-you to vaccine skeptics for their support in November, appoint someone who opposes the government’s traditional role in promoting vaccines, such as Kennedy or Florida Surgeon General Joseph Ladapo, who called for a pause in the use of Covid-19 mRNA vaccines and did not encourage parents to vaccinate their children during a recent measles outbreak.

“The short version is they can create — through their control over money, control over processes and infrastructure at the federal level — enormous havoc,” said Georges Benjamin, executive director at the American Public Health Association. “If you want to see an organization not function, put somebody that’s not qualified to be there, or who may have credentials on paper but is not motivated to really do the job in a way that enhances the public’s health.”

Kennedy’s campaign did not respond to a question about whether he would consider joining a future Trump administration; the Florida Department of Health did not respond to requests for comment from Ladapo.

The former president’s growing criticism of immunization mandates comes as Kennedy tries to woo Trump’s increasingly vaccine-skeptical MAGA base, and as suspicion about the Covid-19 shots spills into other routine childhood immunizations. A POLITICO | Morning Consult poll last fall showed that Republican voters are less likely than Democrats or independents to say vaccines are safe for children; Trump primary supporters were twice as likely as other Republicans to say such vaccines are unsafe, the poll found.

The Trump campaign has previously said that the former president is threatening to take away funding only from schools that mandate the Covid-19 vaccine, not other vaccines. Public health experts don’t think Trump is personally opposed to immunization, and Trump and his wife, Melania, received the Covid-19 shot and in 2021 encouraged “everyone” to “go get your shot.” And states are responsible for establishing most immunization policies.

But public health experts remain concerned about what Trump might do as president or whom he might appoint.

Trump’s campaign did not answer specific questions about what other vaccine policies the former president would or would not adopt, or whether he would consider appointing vaccine-skeptical individuals. The campaign pointed back to his promise to defund schools with vaccine mandates, which spokesperson Caroline Sunshine said in an email still stands.

Former Trump administration officials argue some policy changes are needed to address concerns about how the government communicated with the public during the pandemic and that those policies aren’t anti-vaccine. The conservative Heritage Foundation’s “Project 2025” blueprint, for instance, recommends breaking up the CDC to separate its scientific and policymaking functions.

“Because CDC’s credibility has been so damaged because it bungled the Covid response, people rightfully have a lot more questions about recommendations for everything, vaccine-related and otherwise,” said Roger Severino, vice president of domestic policy at the Heritage Foundation and director of HHS’ Office for Civil Rights under Trump. He added that he doesn’t question the safety and efficacy of any vaccine, but that “there is an additional burden on the CDC to explain with hard science the rationale for all the vaccines on the schedule being taken in combination."

The CDC declined to comment. Former CDC Director Robert Redfield, who served under Trump, did not respond to a request for comment.

Paul Mango, former deputy chief of staff for policy at HHS under Trump, said it’s unlikely the former president would prioritize anti-vaccine policies or appoint anti-vaccine officials in a second administration. Trump did, after all, champion Operation Warp Speed, a public-private partnership that helped develop the Covid-19 vaccine in record time.

“I guess it’s always a possibility, but I think it’s an extremely low probability,” Mango said. “I just don’t see that as a priority. If there's someone who’s great at all of that other stuff and they happen to be anti-vaccine, I don’t know, I don’t know who that individual is, but I don’t think that would be a selection criterion. I really can’t imagine that despite the political rhetoric and the campaign rhetoric.”

But Trump rewarded evangelicals for their support in 2016 with three conservative Supreme Court justices who overturned Roe v. Wade, and public health experts fear what a similar reward might look like for vaccine skeptics. They worry he might appoint someone like Kennedy, who Trump, after he was elected in 2016, asked to chair a “vaccine safety task force,” or Ladapo to a top health position.

Such appointments would represent a stark departure from the broadly respected personnel who served in the Trump administration, such as Alex Azar, a George W. Bush HHS appointee who was a top executive at the drugmaker Eli Lilly; Scott Gottlieb, who worked at the FDA under Bush; and Jerome Adams, who ran Indiana’s health department under then-Gov. Mike Pence. It would also deviate from the approach he took during the Covid-19 pandemic, putting scientists and doctors, such as Deborah Birx, at the forefront of the White House’s messaging.

“If he appoints any of those Fox News talking heads in a leadership position of the CDC or NIH or FDA, absolutely they could do a lot of damage,” said Peter Hotez, co-director of the Texas Children's Hospital Center for Vaccine Development.

Kennedy’s campaign, in a statement, said that he “opposes all vaccine mandates” but has “no intention of amending the CDC childhood recommended vaccine schedule” and would “not use the federal government to force state governments or schools to change their policy on vaccines” if elected president.

A second Trump administration could effect significant change even just by making tweaks to two top vaccine advisory committees — the CDC’s Advisory Committee on Immunization Practices and the FDA’s Vaccines and Related Biological Products Advisory Committee. It could either appoint vaccine-skeptical individuals to the bodies or scrap them entirely.

Such a move would likely have immediate impacts on states, many of which point directly to CDC and ACIP recommendations in their immunization statutes. The CDC puts out yearly recommended immunization schedules for both children and adults.

“Imagine what happens if CDC guidance changes to, ‘Vaccination is a question for families. CDC recommends that families talk to their provider or minister about vaccines,’ and doesn't recommend anything,” said Wendy Parmet, who directs the Northeastern University Law School’s Center for Health Policy and Law. “Some state laws are going to change with a blink of an eye.”

The FDA, in a statement, said advisory committee members must be “technically qualified experts in their field” and be “able to analyze detailed scientific data and understand its public health significance.” It added that while committees provide recommendations, final decisions are made by the FDA.

A future administration could also use the power of the purse, like withholding funding for the federal Vaccines for Children Program, to persuade states to adopt or remove certain vaccine policies. It could defund or reduce funding for the CDC’s work on vaccine recommendations and promoting vaccination. CMS could remove vaccination as a quality measure. The NIH could decide not to fund certain kinds of vaccine research.

Public health experts additionally fear Trump could also end all federal vaccine mandates, including for members of the military, which they say could undermine the nation’s defenses. Military members are required to receive a suite of shots before basic training — against diseases like tetanus, measles and polio — while others have to get additional vaccines protecting them against anthrax or smallpox, though they can opt out on health, administrative or religious grounds.

Even if Trump takes none of those actions — or loses the 2024 election — public health experts warn that the former president’s campaign trail rhetoric is enough to give state and local officials the confidence they need to change their vaccine policies.

Some state and local jurisdictions have already been moving in that direction. In West Virginia, the GOP-controlled Legislature voted to remove vaccine requirements for students in private and parochial schools, though Republican Gov. Jim Justice, who is running for Senate, vetoed the bill. A Houston-area school board voted in May to remove sections from science textbooks that address vaccines.

“Even if it’s your state legislators who are making the decisions that count, if they see a president elected who holds strong anti-vaccine views, or who appoints anti-vaccine administrators, that tells elected officials at the state and local level, ‘Hey, this president was elected on this platform, this must be something that my constituents also care about,’” said Allison Winnike, director of the Western region for the Network for Public Health Law. “It could overnight cause really lasting harms that would take a long time to try to combat.”