The Centers for Disease Control and Prevention’s (CDC) vaccine recommendations committee on Friday wrapped two days of meetings that involved votes on a range of recommendations regarding COVID-19, measles and more.
As NBC News reports, the recommendations panel, known as the Advisory Committee on Immunization Practices, or ACIP, has undergone changes in recent months, with all new members picked by Health and Human Services Secretary Robert F. Kennedy Jr.
The ACIP’s recommendations are not the final say — they must be reviewed and approved by the CDC director to become official guidance, but CDC directors have almost always accepted the recommendations.
RFK Jr.’s Influence Over the Committee
Earlier this year, Health Secretary Robert F. Kennedy Jr. fired the existing panel, installed during the Biden administration, and replaced them with his own handpicked roster, including five members he added just last week. Some of those he chose have a history of being critical of vaccines.
Kennedy’s moves to reshape vaccine policy in the U.S. hinge in part on ACIP’s recommendations. Kennedy has a long-running campaign to question the safety of many vaccines. Since being confirmed he’s limited access to the COVID vaccines, ditched millions of dollars in funding for mRNA vaccine research, and fired many career scientists at CDC, including its Senate-confirmed director, Susan Monarez.
On Thursday, ACIP chair Kulldorff said the panel is setting up two new working groups: one on vaccines recommended during pregnancy and another on the timing of when shots are given on the vaccine schedule. That action indicates that Kennedy’s ACIP will continue to question well-established vaccine practices.
MMRV Vaccine – Separate Only, Not Combined
The panel voted Thursday to change a recommendation on the combined measles, mumps, rubella and varicella (MMRV) vaccine, supporting separate, not combined, MMR and varicella shots for those under the age of 4.
As CBS News reports, the combined MMRV vaccine offers the convenience of one shot instead of two, but it does carry a slightly higher risk of fever-related “febrile” seizures when used as the first dose in young toddlers aged 12-23 months, according to CBS News medical contributor Dr. Céline Gounder. The side effect – which doctors say is very rare – is usually seen between the ages of 14-18 months.
As Gounder explains, febrile seizures are rare and almost always resolve without lasting effects, but are frightening for families and can erode trust in vaccines. By contrast, studies show there is no elevated risk when MMRV is given for the second dose at ages 4 to 6 years old, after children have outgrown the highest-risk window.
On Friday, the panel reversed a vote it took the day before on coverage for the MMRV vaccine. On Thursday, the panel said the Vaccines for Children program could cover the combined shot if parents want it — but the next day they voted that it shouldn’t. The result is that the combined MMRV shot is no longer recommended to be given, and therefore will not be paid for by government insurance.
Changes to COVID vaccine recommendations
In a change from current guidance — which state that the CDC recommends a 2024-2025 COVID-19 vaccine for most adults ages 18 and older — the committee voted on Friday for people to make individual, informed decisions about COVID vaccination, declining to specifically recommend vaccination.
The updated recommendations would include the following:
- Adults 65 and older: Vaccination based on individual-based decision-making, also known as shared clinical decision making.
- Individuals 6 months to 64 years: Vaccination based on individual-based decision-making — with an emphasis that the risk-benefit of vaccination is most favorable for individuals who are at an increased risk for severe COVID-19 disease and lowest for individuals who are not at an increased risk, according to the CDC list of COVID-19 risk factors.
“The good news is anyone can get this vaccine. The bad news is that no one is encouraged to get it even if you’re in a high-risk group,” Dr. Paul Offit, a vaccine researcher at Children’s Hospital of Philadelphia, told The Associated Press. Offit is a former government adviser who has sparred with Kennedy for years.
“What I think it means is that people are going to be uncertain about whether or not the COVID-19 vaccine is of benefit to them,” Dr. Amesh Adalja, senior scholar at Johns Hopkins Center for Health Security, told CBS News. “I think it would have been much better to make a very pointed recommendation for those in high-risk groups to get the vaccine, and for those in low-risk groups, that’s where individual decision-making makes sense.”
Adalja added, “I think this was sort of what you would expect from this committee and who’s on this committee. They have a lot of animosity toward the COVID-19 vaccines.”
There were also multiple votes related to how potential COVID vaccination risks should be communicated to patients. Members of the panel recommended that the CDC update its language regarding potential risks as well as recommended that health care providers communicate risks with their patients on an individual level. This move drew pushback from outside medical groups who fear it may sow distrust in the vaccines despite their proven safety record.
In a close vote, the committee decided against requiring a prescription for COVID-19 vaccination. With a vote of 6 yes and 6 no, the decision went to the ACIP chair, who voted no — keeping the vaccine available without a prescription.
Adalja said insurance plans are mostly expected to continue covering the shots for people who want them, at least through the end of the year.
Hepatitis B is Tabled – For Now
Then came hepatitis B. Although some on the committee seemed enthusiastic about pushing the first dose recommendation for hepatitis B from birth to 1 month of age, after some discussion, there was a revolt against tackling the issue at all.
“I move to postpone the question indefinitely,” Dr. Robert Malone, an ACIP member and close associate of Kennedy, said. “I believe that there’s enough ambiguity here and enough remaining discussion about safety, effectiveness and timing that I believe that a vote today is premature.”
That seemed to take Kulldorff by surprise. The committee voted 11 to 1 to table action on the birth dose of hepatitis B vaccine, with Kulldorff as the lone dissent. Medical experts participating in the meeting as liaisons representing major medical groups seemed relieved by the decision to table the question.
Children’s Health Defense, the anti-vaccine group, founded by Kennedy before he became health secretary, has long targeted the hepatitis B vaccine recommendation, claiming the risk of illness is small for most babies and the vaccine can be harmful.
Many had voiced their opposition to overhauling the recommendations, pointing to data showing the current policy had helped dramatically reduce cases of hepatitis B. The proposed changes also ran counter to hours of data presented by the CDC’s own scientists supporting the safety and efficacy of offering the shot right after a baby is born.
The committee’s decision to table the vote leaves the current recommendations in place, for now.
Tensions Mount Between Medical Professionals and the Committee
Tensions between the committee and established medical professionals have surfaced repeatedly throughout the two-day gathering.
“It is very easy to get distracted by one study that says this or one study that does say that,” noted Dr. Amy Middleman, representing the Society for Adolescent Health and Medicine. “There’s always some risk — there’s a risk to walking across the street. The committee’s scientific challenge is to determine whether the benefits outweigh the risks.” She added that she hoped the panel would use scientific tools like grading evidence to evaluate these questions going forward.
On Thursday, Dr. Jason Goldman, president of the American College of Physicians, urged ACIP not to change the recommendations on the MMRV shot and criticized the broader process, saying they’ve sidelined subject matter experts and clinicians. He also noted that representatives from medical groups have been removed from ACIP workgroups, though they are still able to comment during the public meetings.
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