The two-day meeting of the Centers for Disease Control and Prevention’s (CDC) Advisory Committee on Immunization Practices (ACIP), led by U.S. Health and Human Services Secretary Robert F. Kennedy Jr., was marked by dramatic events on Thursday. The appointment of new members, the revision of old recommendations, the confusion during the vote, and sharp disagreements among experts have left the future of U.S. vaccine policy at an uncertain juncture. The meeting recommended restricting the use of the MMRV vaccine for young children, while the vote on the hepatitis B vaccine, which is crucial for newborns, was postponed. These events have caused concern in the scientific community and the public, and there are fears that this could have far-reaching consequences for the nation’s public health.
The most important decision of the meeting was about the combined MMRV vaccine, which protects against four diseases: measles, mumps, rubella, and varicella (chickenpox). The committee voted 8-3 to recommend that children under 4 not receive the combined vaccine. Instead, they should receive two separate vaccines, MMR (measles, mumps, rubella) and varicella (chickenpox), because this reduces the risk of febrile seizures.
Clinical studies have shown that giving children aged 12 months the combined MMRV vaccine doubles the risk of febrile seizures compared to giving them two separate vaccines. However, this risk is still very low – only 4.3 cases per 10,000 doses.
Voting confusion over US vaccine policy
Dr. Joseph R. Hibeln, Dr. Hilary Blackburn and Dr. Cody Meisner voted against the recommendation, while Dr. Robert Malone abstained due to a conflict of interest. Notably, the committee also voted against implementing the recommendation for low-income children under the Vaccines for Children (VFC) program. This means that children who receive free vaccines under the VFC program will be able to choose between the combined or separate vaccines, while others will only be recommended for different vaccines. The decision caused confusion among many members, as it resulted in two sets of recommendations.
Since 1991, the CDC has recommended that all babies receive their first dose of hepatitis B vaccine immediately after birth, before they go home from the hospital. This policy has reduced the number of hepatitis B infections in babies from 18,000 to just 20 cases per year.
The committee considered whether babies whose mothers tested negative for hepatitis B should be vaccinated a month later, rather than at birth. Anti-vaccination activists and Robert F. Kennedy Jr. has questioned the need for the vaccine, as the virus is primarily spread through sexual contact or the use of contaminated needles.
Risk Awareness:
Many experts have strongly opposed the change. Hepatitis B is 100 times more infectious than HIV and can survive on surfaces for up to seven days. It can also be spread by bites from other household members or children in daycare. Delaying vaccinations will leave children vulnerable to these risks and increase their risk of long-term liver disease, cancer, or death if they become infected. According to Dr. Ravi Zaveri, “The current recommendation is the best and is the standard of care.”
Changes and growing concerns at the US Vaccine Policy Committee
The confusion and controversial decisions at the meeting are believed to be the result of dramatic changes to the ACIP committee by Health Secretary Robert F. Kennedy Jr. In June, Kennedy removed all 17 current members and replaced them with members of his choosing. Many of these new members lack expertise in vaccination or have made unsubstantiated claims about vaccines.
Several former CDC directors and health experts have expressed deep concern about the changes. Dr. Jason Goldman, president of the American College of Physicians, said, “This is the beginning of the end, as they are losing faith in the process.” He said the decisions were being made without proper scientific debate and were putting public health at risk.
Nine former CDC directors wrote in an op-ed that Kennedy’s decisions were “unprecedented” and that he had filled CDC advisory committees with “unqualified individuals” who were pushing “dangerous and unscientific ideas.” Dr. Richard Besser, president of the Robert Wood Johnson Foundation, warned that “if the committee continues down this path, our nation’s health will be in grave danger. Lives are at stake.”
Revisiting old and proven vaccine recommendations without any new scientific evidence, confusion during voting, and open disagreements among experts all threaten to undermine public trust in vaccines and the scientific process. The consequences of this meeting will not only affect vaccine availability or insurance coverage, but could also set a dangerous precedent for the future of American public health. In the coming days, the decisions on COVID-19 and hepatitis B vaccines will be the focus of the world’s attention, as they will determine the future direction of American health policy.