A US Federal Committee Is Meeting To Discuss Vaccines

On Thursday, September 18, the Advisory Committee on Immunization Practices (ACIP) – which advises the US Centers for Disease Control and Prevention (CDC) on vaccines – met to vote on updates to guidance for three vaccines. With some of the discussions postponed to Friday, September 19, scientists from around the world have been explaining what the ACIP has said so far, and what this could all mean for Americans and their access to vaccines.

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What is the ACIP?

According to the CDC’s own website, the ACIP is “a federal advisory committee that develops recommendations on the use of vaccines in the civilian population of the United States.” It’s with their guidance that the CDC decides who should get which vaccines and when.

In June of this year, Health and Human Services Secretary Robert F. Kennedy Jr took the audacious decision to “reconstitute” the entire ACIP, removing all 17 sitting members and restaffing it with his own picks.

“A clean sweep is necessary to reestablish public confidence in vaccine science,” said Kennedy in a statement at the time. Others expressed concerns that many of the new appointees to the ACIP had openly questioned the science behind vaccines.

“Since taking office, Health Secretary Robert F. Kennedy Jr. (RFK Jr) has purged the committee of experienced experts and replaced them with merchants of doubt,” writes Dr Helen Petousis-Harris, Associate Professor at the University of Auckland, in a blog post.

New members were being added to the panel as recently as September 15 in advance of the meeting, which is one of three the committee typically holds each year. They are livestreamed to the public, who are also invited to submit comments.

Even before this most recent meeting, the new-look ACIP had been getting down to the nitty gritty with a vote on flu vaccines. They did vote to endorse seasonal flu vaccines for all Americans aged 6 months or older, but specified that these should only be single-dose, thimerosal-free shots.

Thimerosal is a preservative that is only included in a tiny fraction of flu vaccines anyway. It’s been used safely for years, and research has consistently found no link with any sort of negative health impact, despite the best efforts from antivax campaigners to suggest that it can cause a toxic buildup of mercury in the body.

What’s the latest from the ACIP meeting?

Now the ACIP is turning its attention to the MMRV (measles, mumps, rubella, and varicella), COVID-19, and hepatitis B vaccines.

As reported by The Hill’s Joseph Choi, the panel was asked Thursday to consider whether the age recommendation for the MMRV shot should be shifted. It voted 8-3 (with one abstention) to end the recommendation for this vaccine to be given to children under 4 years of age.

The shot combines the well-known MMR vaccine with a vaccine against chicken pox. This combination is not as widely used outside the US, but separate MMR and varicella vaccines are, and the MMRV is considered safe and effective.

There’s perhaps no greater lodestone for the antivax community than the MMR vaccine. Despite decades of careful research and millions of dollars of funding producing results that time and time again countermand their narrative, some are still determined to believe that this vaccine is associated with neurodevelopmental conditions like autism.

Recent actions from the Trump administration are unlikely to do much to help put this to rest once and for all – the CDC announced further funding to investigate this debunked “link”, and Kennedy himself claimed we would “know the causes of autism” by this month.

The ACIP’s vote to change the guidance around the MMRV could feed into the mistaken impression that the vaccine is unsafe or untrustworthy.

It’s recommended that children receive two doses of MMR in early childhood for best protection against measles, mumps, and rubella. Current US recommendations say that children may get either the MMRV or separate MMR and varicella vaccines for their first dose.

There’s a slightly increased risk of children experiencing a febrile seizure (FS) after the MMRV, so for the very youngest children, it may be recommended that separate vaccines are used.

However, as Professor in Clinical Vaccinology Nick Wood told the Australian Science Media Centre, “Even if a child has a febrile seizure after vaccination, their outcomes are no different to FS following a fever from another cause, such as an infection.”

FS is distressing for parents, but it is common in young children. “One child in 30 will have a febrile seizure as a result of fever,” Wood explained.

“What we have just seen at ACIP is frankly extraordinary”

The change in recommendations for the MMRV shot may not have been the most notable thing to come out of Thursday’s meeting.

“What we have just seen at ACIP is frankly extraordinary – and not in a good way,” Petousis-Harris told the Aotearoa New Zealand Science Media Centre.

“As of this writing, after protracted confusion, the committee has voted in a contradictory way on the combined measles-mumps-rubella-varicella (MMRV) vaccine. Members first voted against recommending MMRV for young children, and then stumbled through a second vote about whether the Vaccines for Children program should continue to cover it.”

Vaccines for Children (VFC) is a federally funded program providing shots at no cost to children without adequate insurance. It automatically covers all ACIP-recommended childhood vaccines. This time, however, the ACIP were asked to vote on whether the MMRV eligibility under VFC should be changed, and they said no.

Or, more accurately, several members abstained, and there appeared to be some confusion on what the vote was even about.

“This new handpicked ACIP has chosen to address issues that were relatively settled science for which there’s no new information that really suggests a need to do a detailed review,” Professor Andy Pavia of the University of Utah told The Hill before the meeting. Petousis-Harris called it “policy-making by pantomime.”

What it amounts to is that there will be no change to what vaccines are covered under the VFC for now, despite the ACIP recommending (literally minutes prior) that under-4s should be given the MMR and varicella vaccines as separate shots.

What’s to come?

Next, attention will turn to hepatitis B and COVID-19.

COVID vaccine eligibility is already causing confusion across the United States. Prominent medical organizations filed a lawsuit in July against the Health Department’s decision to remove the vaccine from the CDC’s recommended schedule for “healthy children and healthy pregnant women”.

We’ll have to wait and see how the ACIP votes, but experts in obstetrics and reproductive health have been coming out in support of continuing to offer the COVID-19 vaccine as standard during pregnancy.

“I know of 49 studies, looking at outcomes for more than half a million mothers and babies following COVID vaccination in pregnancy, compared to those who did not receive the vaccine. None of these found mRNA COVID vaccination associated with any problems in pregnancy, at birth, or in babies up to 18 months old,” said Dr Victoria Male of Imperial College London to the UK Science Media Centre.

On hepatitis B, the vaccine has been in use in newborn babies for many years and is considered safe.

“Newborns infected with hepatitis B at birth and infants infected in the first year of life have a 90 percent chance of developing chronic hepatitis B, and 25 percent of those who develop chronic hepatitis B will die from the disease,” Wood explained.

With no cure for the infection once it takes hold, vaccinating newborns is a highly effective way of preventing chronic disease in cases where they may have been infected during labor and delivery.

Professor Julie Leask AO, of the University of Sydney, added that a previous suspension of the hepatitis B vaccine recommendation in the US saw a decline in coverage and led to infants being exposed to the virus at birth. There are concerns that a similar outcome could be seen if the ACIP votes to water down the current universal recommendation.

Change is afoot. Moves are being made across the US to provide an alternative source of vaccine information beyond the ACIP-informed CDC. Just this month, California, Oregon, and Washington announced an alliance to provide public health information to their residents, calling the CDC a “political tool”. Hawai'i joined almost immediately.

There’s also the Vaccine Integrity Project, a group of public health experts brought together with the stated aim of combating government misinformation on vaccines. This landscape is becoming ever more complex – and the conversation ever more fraught.