The committee that offers vaccine advice to the nation’s top public health agency voted Friday against recommending the updated COVID-19 vaccine to people aged 6 months or older, instead leaving the decision to individuals. The panel also decided against recommending that states and local authorities require a prescription for COVID-19 vaccines.
On many levels, people watching the two-day proceedings of the Advisory Committee on Immunization Practices (ACIP) did not know what to expect. Much of the week was uncharted, and a planned vote on the hepatitis B vaccine was tabled despite being on the agenda.
The unpredictable meeting followed a full shakeup by Health Secretary Robert F. Kennedy Jr. to rid the expert advisory panel of what he claims are the pharmaceutical industry’s corporate interests.
Kennedy made what he called “a clean sweep” in June when he fired the entire committee and replaced them with his handpicked selections. These new members included noted vaccine skeptics and conspiracy theorists. Some members joined the committee as recently as this week.
The advisory committee’s performance appeared “sloppy” and highlighted how “medicine is an art and a science,” said Dr. Georges Benjamin, executive director for the American Public Health Association.
“You have a committee, and you bring one new person in, that changes the whole dynamics,” Benjamin said. “A lot of these folks are on a very steep learning curve because they’re not vaccine specialists – most of them.”
Here are four takeaways from the meeting and how the panel’s decisions will affect health policy.
The committee tried to fight its image
Committee chair Martin Kulldorff opened the meeting by rejecting criticism that panel members were anti-vaccine and challenging previous directors of the Centers for Disease Control and Prevention to a debate about vaccine science. Other committee members pushed back at the characterizations they have faced.
Dr. Joseph Hibbeln, a psychiatrist and Omega-3 fatty acid researcher who serves on the committee, said the members did not enter the conversation with “pre-determined attitudes or pre-determined opinions,” but instead were respectful of others, even during disagreements: “We are not, as a committee, anti-vaxxers.”
But the manner in which the ACIP was reshaped in recent months, and Kennedy’s statements and actions on vaccines, has worked to undermine public health workers and institutions, said Jennifer Nuzzo, an epidemiologist who directs the Pandemic Center at the Brown University School of Public Health.
Nuzzo specifically pointed out how many of the committee members had criticized research about infectious diseases, including COVID-19, at the meeting and demanded more research. During the proceedings, their arguments often relied upon personal stories, such as their own experiences getting vaccine information at their local pharmacy, rather than data and evidence.
“Water cooler conversations [do] not amount to epidemiology,” Nuzzo said. “There’s a lot of reasons why anecdotes may be misleading. Sometimes, they do suggest something else is going on, but you have to do rigorous studies to figure it out.”
COVID-19
Much of Friday’s discussion was consumed with a technical review of COVID-19 infection rates, and deliberations grew tense. During public comments, health experts said the committee’s proposed recommendations for COVID-19 vaccines created more confusion and erected more barriers at a time when people are losing health care coverage and communities are experiencing worsening health outcomes on multiple fronts.
Retsef Levi, a professor at the MIT Sloan School of Management, chaired the committee’s COVID-19 working group. According to his presentation of the group’s findings, assessed levels of protection from COVID-19 vaccines against hospitalization, death and long COVID “are based on very low-quality data and analyses,” he said. “That is a major uncertainty we all have to acknowledge.”
“We feel the vaccines should be prescribed,” he said, adding that the group recommended that state and local authorities should require prescriptions for COVID-19 vaccines. The outcome for that measure was up in the air through the vote itself on Friday, which resulted in a 6-6 tie. Kulldorff cast the deciding “no” vote as the committee’s chair.
Dozens of medical societies, including the American Medical Association, the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists, have touted the safety and efficacy of COVID-19 vaccines and have recommended their use to prevent severe health outcomes and death linked to the disease.
The trade association AHIP, formerly known as America’s Health Insurance Plans, which represents health insurance companies, issued a statement Tuesday saying that companies planned to cover vaccines based on recommendations that already were in place as of Sept. 1 until the end of 2026. They did not wait for this week’s ACIP meeting before deciding to extend coverage.
“While health plans continue to operate in an environment shaped by federal and state laws, as well as program and customer requirements, the evidence-based approach to coverage of immunizations will remain consistent,” the group said.
Dr. Tom Frieden, former CDC director during the Obama administration, told PBS News Hour’s Ali Rogin that the insurer association’s decision marked “a huge vote of no confidence” in the vaccine advisory panel’s process.
“And that’s unfortunate,” Frieden said. “I think, stepping back, you have to look at what this administration, and particularly Secretary Kennedy, is doing, rather than what he is saying. He’s saying he wants to restore trust. He just destroyed trust of the insurers.”
Even as vaccine uptake rates decline nationwide, physicians and public health experts urged the committee to protect access to vaccines for people who still wanted to acquire that level of protection for themselves and their families.
“Low uptake should not limit access to those who want to be vaccinated and reduce their risk for severe outcomes,” said Dr. Robert Hopkins, Jr., medical director of the National Foundation for Infectious Diseases.
What actually happens in reality is “hard to say,” said Dr. Sean O’Leary, an American Academy of Pediatrics fellow, who pointed out during a call with reporters that Kennedy’s committee has “sown confusion.”
Hepatitis B
On Thursday, after hours of deliberation, the committee attempted to vote, then postponed and ultimately tabled a vote that would have delayed dosage of the hepatitis B vaccine for newborns until a month after they are born.
Hepatitis B, an infectious disease that weakens the liver and is transmitted through blood and bodily fluids. It often takes months for symptoms to become obvious, heightening the risk of subsequent transmission to others. People who engage in intravenous drug use with shared needles are at higher risk of contracting the disease.
As few as 1 in 4 people in the U.S. who are estimated to be sick with hepatitis B are diagnosed, meaning many people are unaware they have been infected. Testing is possible, but stigma often inhibits people from asking for the test or having more candid conversations with their health care providers.
Because the disease can be passed from a pregnant person to their fetus, the vaccine for hepatitis B has been available and administered in the United States to newborns within their first hours of life, a practice that has been in place since 1991.
The vote to change the timing of when infants receive the vaccine began to unravel as presentations began. Leading up to the committee’s decision to ultimately table the vote, a feeling of uncertainty persisted among ACIP members who seemed increasingly unconvinced that their vote on hepatitis B vaccines was necessary at this time, given its benefits. The vaccine has been deemed safe and effective in controlling the disease’s spread.
“The optimal approach seems to be to have a standard recommendation,” said Dr. Cody Meissner, a committee member. “It’s very hard to identify people who are most likely to be exposed and infected to hep b, such as IV-drug users, sex workers, homeless people. You can’t find them. It’s hard to get them vaccinated.”
Parents and families “don’t understand the discussion of the subtleties that we’re going through,” said Hibbeln. “If we make a major change in what has been a successful vaccine campaign, we have to have a darn good reason.”
Multiple experts asked why the committee was pushing this vote at all and given the vaccine’s long-running track record of safety and effectiveness.
“I would urge the committee to follow the methodical process of an evidence-based science,” said Dr. Amy Middleman, a professor of pediatrics at the University of Oklahoma’s College of Medicine. “Please, please do that for public confidence and in order to make sure the science is adequately and appropriately vetted.”
Experts later praised the decision to table the hepatitis B vote as being the correct choice because of the implications of delaying its administration on newborns, families and public health.
Measles, mumps, rubella and varicella
Also on Thursday, ACIP members voted to remove the option for a combined vaccine that boosts protection against measles, mumps, rubella and varicella (MMRV) for kids under age 4. Instead, the committee voted 8-3 to recommend that toddlers up to age 3 receive an MMR vaccine with a separate dose to protect against varicella, also known as chickenpox. This option already exists and some physicians already recommend it to caregivers.
WATCH: RFK Jr.’s hand-picked vaccine panel recommends new restrictions on MMRV vaccines
“HHS will examine all insurance coverage implications following today’s ACIP recommendation, prior to a final decision on adoption” by CDC Acting Director Jim O’Neill, according to a statement issued by HHS.
During their discussion, committee members expressed concern about a slightly increased risk of febrile seizures in young children who receive the MMRV vaccine. But O’Leary said these cases are rare and “benign.” He said health care providers had preferred to deliver the combination vaccine “because it’s less pokes for children.”
The American Academy of Pediatrics stands by its recommendation to “offer parents the choice,” O’Leary. “Now, what they’ve done is take away the choice for parents” of children under age 4, he said.
“The AMA is concerned that this change not only reduces parental choice, but also reflects ACIP’s reliance on selective data in forming its guidance,” said Dr. Sandra Fryhofer with the American Medical Association.
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