An influential committee that helps craft federal vaccine policy and recommendations for the Centers for Disease Control and Prevention begins a two-day meeting in Atlanta Wednesday.
The Advisory Committee on Immunization Practices, or ACIP, often meets in obscurity, but was thrown into the spotlight two weeks ago when Health Secretary Robert F. Kennedy, Jr. fired all 17 seated members of the panel and replaced them with a smaller selection of his own.
The committee meets over the objections of Senators Bill Cassidy, R-La., and Patty Murray, D-Wash., chair and former chair of the Senate Health, Education, Labor and Pensions committee, who have both called for the meeting to be postponed over concerns about the new committee members.
The committee typically meets three times a year in public meetings to discuss and vote on how vaccines, approved by the Food and Drug Administration, should be used to protect public health.
The runup to this week's meeting has been chaotic and controversial, according to several current and former CDC staffers who were involved in preparing for it.
It will be closely watched by those concerned about the direction of vaccine policies under Kennedy. "It will be hard to look away," says Jason Schwartz, associate professor at the Yale School of Public Health. "We'll see a lot about what this next chapter for vaccine policy looks like."
The Department of Health and Human Services did not respond to NPR's request for comment on this story.
Fears of politicization
Kennedy's firing and replacing the entire slate of advisers shifts the fundamental purpose of the group, says Schwartz.
"This has been an apolitical group of public servants, volunteers from the scientific and medical community who have gone through their terms independent of changes in the political administration and in CDC leadership," he says. "That we're thinking about 'Biden ACIP members' and 'Trump ACIP members,' that this is being viewed — like the Supreme Court — in terms of who has a majority, is unprecedented in the committee's history."
The ACIP has played a key role in U.S. vaccine policy since it was formed in the 1960's. At the time, new vaccines for measles and polio had recently come online, and national health leaders felt the need for a regular panel of experts to determine how best to use these and other products to protect the public.
So they brought together specialists on medicine, public health and children's health to weigh and discuss the available evidence.
Now the committee makes recommendations that, with the CDC director's approval, become policy. Committee members help set the national vaccine schedule which state and local jurisdictions and doctors rely on. Their votes affect which vaccines insurers will cover and the federal government will pay for, for low-income kids.
A break with precedent
In late May, Kennedy announced that he was changing the vaccine schedule without ACIP's input – a breach in the transparent, consensus-driven way the schedule had been made for decades.
He directed the CDC to remove the recommendation that children and pregnant women get routine COVID-19 vaccines.
"No one from CDC who works on vaccine policy was involved in that process. No one knew that was coming," says Dr. Fiona Havers, a former senior CDC official who left the agency in June. "For RFK Jr. to be unilaterally dictating to CDC what the vaccine recommendation should be was shocking."
For Havers, who led the team that analyzed hospitalization data for COVID and RSV and was previously scheduled to present at this week's meeting, Kennedy's subsequent firing of every ACIP committee member was the last straw.
"I knew I was done at that moment," she says. "For my own scientific and personal integrity, I did not feel like I could present to this committee and help legitimize them."
New members with a record of questioning vaccines
Many of the panel's eight new members don't have deep, current expertise in vaccines. Some rose to prominence in recent years by spreading false claims about them.
For instance, Retsef Levi, a professor at the MIT Sloan School of Management, has said on social media that COVID vaccines are killing young people and must be stopped. Dr. Robert Malone, who had worked on early research into mRNA technology but is now critical of mRNA vaccines, has suggested that COVID vaccines may cause cancer. Neither of these claims are true.
Martin Kulldorff, an epidemiologist and biostatistician formerly at Harvard who will serve as the new ACIP chair, has been paid to serve as expert witnesses in litigation against the drug company Merck, as has Malone.
Vaccine supporters worry that this panel could be dismissive of vaccines and discourage their use.
"I don't feel like I can trust the information and recommendations from ACIP now," says Dr. Alexandra Cvijanovich, a pediatrician in Albuquerque, N.M., and a spokesperson for the American Academy of Pediatrics.
The mixed messaging from the Kennedy-led HHS is confusing for patients, she adds.
"People who have always trusted vaccines are now beginning to second-guess them," she says. "And then people who have had full faith in our vaccine system are now worried that it's been taken apart with the dissolution of the original ACIP committee." Parents have asked her about the accessibility and safety of future vaccines, she says.
Meeting agenda items raise flags
In the past, ACIP's public meetings have been reassuringly predictable. Committee members sit through data presentations, ask thoughtful questions, and vote when asked. It tends to go smoothly because it takes months to years of work behind the scenes — by committee members, CDC staff and other stakeholders — before they present a final analysis and bring a product to a vote.
Some topics were dropped from the agenda for this week's meeting, such as discussions on vaccines that protect against cervical cancer and pneumonia. The abrupt firing of the previous committee made it impossible for the related work groups — who can't meet without active ACIP members — to finish their work, according to current CDC staff, who requested anonymity because they were not authorized to speak for the agency.
Instead, those topics have been subbed out for some long-standing priorities for people who question vaccines.
There's a vote scheduled over thimerosal, a preservative used in influenza vaccines. Back in the mid to late 1990's, there were theories that it could be a cause of autism in children.
That claim has long been disproven. Even so, manufacturers voluntarily removed it from childhood vaccines.
It's used infrequently today and there hasn't been much new research on it for years, according to a CDC briefing posted in the ACIP meeting materials in advance of the meeting.
Still, the group will be asked to vote on a recommendation on the topic, after reviewing a presentation by Lyn Redwood, a registered nurse and former president of Children's Health Defense, the anti-vaccine advocacy group that Kennedy used to chair.
The inclusion of the MMRV (measles, mumps, rubella, and varicella, aka chicken pox) vaccine on the agenda also comes as a surprise to vaccine policy experts at the Vaccine Integrity Project, an initiative housed at the University of Minnesota which is working to safeguard vaccine policy and access.
Years ago, there was evidence that the MMRV vaccine was linked with seizures during fevers in some young children. The committee addressed it then by recommending that young kids be vaccinated separately for chicken pox — a policy that hasn't changed in more than 15 years.
"It is possible that there are new data, but CDC experts with decades of experience haven't seen them," says a briefing from the Vaccine Integrity Project. Still, it's up for discussion at this meeting.
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