Robert F. Kennedy Jr.’sThe vaccine advisory committee decided to cease recommending the combined vaccine that safeguards against measles, mumps, rubella, and chickenpox for kids under four, indefinitely delayed a vote on the hepatitis B vaccine schedule, and shifted away from a general recommendation for the COVID-19 vaccine during a disorganized two-day session.
On Thursday, the Advisory Committee on Immunization Practices (ACIP) cast a vote of 8 to 3, with one member abstaining, and advised that children younger than 4 should no longer be given the MMRV vaccine, instead receiving the MMR and varicella (chickenpox) vaccines individually. The committee had originally planned to vote on whether all newborns should continue to receive the hepatitis B vaccine, but opted to delay that decision until a future date on Friday. Later that same day, the committee turned down a suggestion that would have mandated prescriptions for the COVID-19 vaccine at the state and local levels, while also deviating from earlier recommendations regarding who should receive the vaccine.
The ACIP is a group of specialists who offer vaccine guidance to the Centers for Disease Control and Prevention (CDC). The committee members were recently named by the health secretary, following hisremovedall the former members of the committee this summer.Many of the new participantshave shown doubt about vaccines or have limited knowledge of the topic, leading to criticism from medical and scientific groups, who have issued their own vaccination guidelines that differ significantly from ACIP’s recommendations.
Public health professionals have largely recognized the vaccines for MMRV, hepatitis B, and COVID-19 as effective in reducing disease rates, yet some members of the ACIP expressed concerns about their safety and effectiveness this week. During various sessions of the meetings, outside experts, including those from reputable medical groups like the American Medical Association and the American Academy of Pediatrics, voiced criticism regarding the recent modifications to the ACIP meeting procedures. These individuals, who previously acted as liaison members to ACIP, wereremovedfrom the working groups of the ACIP, where they contributed their knowledge in evaluating and reviewing data regarding vaccines and provided summaries of this research to the broader ACIP committee.
Here’s what you need to be aware of regarding the latest guidelines.
What is the latest suggestion for the MMRV vaccine?
Until this point, the CDC hasrecommendedThe measles, mumps, and rubella (MMR) vaccine or MMRV, which also covers chickenpox through the varicella vaccine, allows families and their doctors to decide which option to use. Both vaccines can be administered in two doses: the first for children between 12 and 15 months, and the second for those aged 4 to 6 years. On Thursday, the ACIP advised against using the combined MMRV vaccine for children under 4; however, the guidelines for the separate MMR vaccine and varicella vaccine continue to stay unchanged.
In a step that seemed contradictory to that choice, ACIP also voted on Thursday to have theChildren’s Vaccines (VFC) programContinue to pay for the MMRV vaccine for kids under 4, in a vote of 8 to 1. The VFC program offers vaccines to roughly half of all children in the U.S. at no cost or a reduced price. The decision caused confusion among committee members, with three ACIP members choosing not to vote—one explained that he abstained because he didn’t comprehend what he was voting on.
I’m going to refrain from voting because I’m not entirely clear about what I’m supporting,” said Dr. Cody Meissner, a pediatrician at Dartmouth Geisel School of Medicine and one of the more seasoned vaccine experts, who was part of the Food and Drug Administration’s vaccine advisory committee during the approval process for the COVID-19 vaccines. “I don’t want there to be a difference between children who receive their vaccine through VFC and those who don’t. That wouldn’t be fair.
When the committee met again on Friday, the members revisited the VFC vote. This time, the Muara Digital Team, the panel changed their previous decision, with 9 members voting in favor and 3 choosing to abstain, aligning the coverage with the ACIP’s updated recommendation. As a result, the VFC program will no longer cover the MMRV vaccine for children under four years old. However, the separate MMR and varicella vaccines will still be covered by the program.
CDC representatives shared information during Thursday’s meeting suggesting that the MMRV vaccine may lead to a slightly higher chance of fever-induced seizures in children between 12 and 23 months old, when compared to the MMR vaccine. Although some ACIP members raised worries about this possible adverse reaction, other professionals pointed out that such seizures can occur with various childhood diseases, not solely due to the MMRV vaccine, andoften resolve by themselves without long-term consequences.
Most children—approximately 85%—receive separate MMR and chickenpox vaccinations; only around 15% receive the combined MMRV vaccine, as reported by CDC data during the meeting. Nevertheless, several outside experts who attended the meeting on Thursday criticized the suggested adjustment in ACIP’s recommendation, arguing that it would reduce parents’ choices and create confusion among the general public.
What we’re implying is that we don’t have confidence in parents to make a choice,” Meissner stated. “If a parent wishes to receive a single dose, why are we removing that possibility?
Dr. Jason Goldman, an internal medicine physician and president of the American College of Physicians, who serves as a representative to the ACIP, voiced his disagreement during Thursday’s meeting. He stated that the change does not consider the viewpoint of “actual practicing clinicians and how we handle vaccine hesitancy and communicate with our patients.” He expressed worry that altering the recommendation could “provide justification” for insurance companies to cease covering the cost of the MMRV vaccine for children under four years old.
I believe this suggestion will lead to greater confusion among the general population,” Goldman stated. “You are removing the opportunity for parents to have informed consent and dialogue with their doctor regarding what is best for their children’s health and well-being.
“I call on this committee to refrain from altering the suggestions if their genuine intention is to empower parents to determine what’s best for their child and enable them to make the decision in collaboration with their doctor,” he added.
What was the decision made by ACIP regarding the hepatitis B vaccine?
Following a vigorous discussion among ACIP members and other professionals, the committee chose to postpone a vote on potential modifications to the hepatitis B vaccination schedule.
The debate focused on the timing of the first dose of the hepatitis B vaccine, which safeguards against a very contagious illness that can harm the liver. At present, the CDCrecommendsthe vaccine is administered in three shots: the first at birth; the second between 1 and 2 months old; and the third between 6 and 18 months of age. the acip considered modifying the guideline so that the initial dose of the vaccine would not be given until a child is at least one month old, unless the newborn’s mother is identified as having hepatitis B.
CDC researchers shared information during Thursday’s meeting showing that the hepatitis B vaccine is safe and effective starting with the first dose. They highlighted that giving the vaccine as soon as possible after birth increases its ability to stop the spread of the disease from mother to child. Researchers also noted that babies may still be at risk of coming into contact with hepatitis B even if their mother tests negative for the virus, such as if the infant lives with someone who has a long-term hepatitis B infection.
A universal birth dose serves as a vital safety measure for infants who might have undetected exposure to [hepatitis B] during pregnancy or in early childhood, which can lead to severe consequences,” said Adam Langer, a CDC representative, at the meeting. “The earlier an infant begins the hepatitis B vaccination series, the quicker the baby will be safeguarded from these early childhood exposures.
Public health professionals have recognized the hepatitis B vaccine as a crucial public health measure, attributing its success to a substantial decrease in cases of transmission from mother to child within the nation.
Some outside experts raised questions about why the timing of the shots was being revisited, especially since it has been a standard part of the childhood vaccination schedule, unless there is strong evidence connecting the birth dose to safety issues. Nevertheless, some ACIP members expressed concerns about the vaccine’s safety, proposing that only infants born to mothers who tested positive for hepatitis B should receive the vaccine at birth.
However, Meissner stated that it’s “very difficult” to determine individuals who are at a greater risk of contracting and being exposed to the illness; for example, those who are homeless or involved in sex work might experience irregular access to medical care. Other specialists also noted that numerous people are unaware they are infected with hepatitis B.
I believe we have discovered through various vaccines that the more we attempt to specify a particular group to vaccinate, the less effective we become,” Meissner stated. “The best method appears to be implementing a general recommendation.
Dr. Evelyn Griffin, a member of the ACIP and an ob-gyn who has previously raised concerns about the safety and efficacy of COVID-19 vaccines, stated that pregnant individuals can be tested for hepatitis B at the location where they deliver, with results often available within hours. However, several experts contended that this might not always be feasible—for example, not all pregnant people deliver in a hospital, or laboratory backlogs could delay the receipt of test results.
In an ideal world, we would be aware of every individual with hepatitis B; they would all receive proper care, and laboratory tests at birthing hospitals would be conducted swiftly, simply, and openly,” said Dr. Grant Paulsen, who serves as a representative to the ACIP from the Pediatric Infectious Diseases Society, during the meeting. “Regrettably, we exist in an imperfect world and must make public policy decisions based on what is most beneficial for the broader population, rather than the stories from my hospital or yours.
What was the decision made by ACIP regarding the COVID-19 vaccine?
Following a long and intense debate regarding the COVID-19 vaccine, the ACIP announced on Friday that it would not advise state and local authorities to mandate a prescription for receiving the COVID-19 vaccine. The panel was split, with 6 members supporting the recommendation and 6 opposing it, leading the decision to be decided by the committee chair, Martin Kulldorff, who cast a negative vote.
Both outside specialists and ACIP participants voiced worries that mandating a prescription could add extra obstacles for individuals trying to get the COVID-19 vaccine, especially for those residing in remote regions, lacking insurance, or having limited access to medical professionals.
It has always been evident that vaccines serve as a key public health approach for prevention,” said Dr. Amy Middleman, who acts as a representative to the ACIP from the Society for Adolescent Health and Medicine, during the meeting. She contended that mandating a prescription for the vaccinations would “overburden” medical offices. “It worries me that for a primary prevention method, we [would] actually [be] creating access issues and obstacles, instead of reducing them.
The committee approved without opposition to revise the existing vaccination guidelines for COVID-19: for adults aged 65 and above, the ACIP suggests that immunization decisions should be made on an individual basis; and for those between 6 months and 64 years old, the ACIP advises that vaccination choices should also be based on personal assessment, but “with a focus that the risk-benefit ratio is most positive for individuals who have a higher likelihood of severe COVID-19 and least favorable for those with lower risk.”
This shift conflicts with the majority of professional medical groups, which still advise annual COVID-19 vaccinations for individuals six months old and above.
Currently, the CDC recommendsThe vaccine is available for most adults aged 18 and older, while parents of children between 6 months and 17 years are advised to make the decision in collaboration with their healthcare providers. Currently, it remains uncertain how the ACIP’s updated guidance will impact access to the shots, although it may create challenges based on state-specific regulations.
Kennedy’s vaccine policy changes
The head of the CDC can either approve or disapprove of ACIP’s suggestions. The agency’s acting director, Jim O’Neill, has been chosen to take over from Susan Monarez, who served as CDC director for less than a month before she was replaced.fired. She testifiedTestifying before a Senate committee on Wednesday, she stated that Kennedy urged her to approve all ACIP recommendations in advance—claims she described as “contrary to my oath of office.” She mentioned that she refused to follow this request, which resulted in her being fired.
ACIP’s updated guidelines represent the most recent adjustments to the nation’s vaccination policies, under Kennedy’s leadership.
Kennedy, a prominent vaccine skeptic, stated in May that the CDC wouldno longer recommendVaccines for COVID-19 for pregnant women and healthy children. Several well-known medical organizations, including theAmerican Academy of Pediatricsand the American College of Obstetricians and Gynecologists, issued their own guidelines that differed from federal suggestions.
Last month, the United States Food and Drug Administration (FDA)saidThis year’s COVID-19 vaccines will only be authorized for individuals aged 65 and above, or those who are at higher risk of experiencing severe symptoms from the virus. Earlier, the vaccinations were advised for everyone over the age of 6 months.
