A vaccine advisory committee handpicked by U.S. Health and Human Services Secretary Robert F. Kennedy Jr. met in Atlanta this week to consider whether to revise recommendations on shots against COVID-19, hepatitis B, and a combination shot that protects children against measles, mumps, rubella and chickenpox.
The panel, which is charged with making vaccine recommendations, declined to recommend COVID-19 vaccines, saying instead that people could make individual decisions — a move that adds confusion as people weigh whether to get a dose this fall.
During the sometimes chaotic two-day meeting, the panel also recommended new restrictions for a vaccine that protects against chickenpox as well as measles, mumps and rubella. In a surprise move, the group indefinitely postponed an expected vote on hepatitis B shots given to infants on the day they are born.
With Kennedy, a vaccine skeptic, leading the country’s health agencies, the meeting of the Advisory Committee on Immunization Practices, or ACIP, struck a different tone from past gatherings. Among the 12 members, all chosen this year by Kennedy after he fired the previous 17-member panel, are people who have criticized and spread misinformation about vaccines. Critics say the panel’s makeup and agenda could sow distrust in the shots.
The panel’s recommendations will be sent to the director of the Centers for Disease Control and Prevention, an agency that has been rocked by disagreements over Kennedy’s vaccine policies. The panel’s recommendations are usually adopted by the CDC, and then widely followed by doctors and insurers.
Here are some takeaways from the meeting.
Panel declines to recommend COVID-19 shots for anyone
The panel on Friday debated COVID-19 vaccinations as the virus has remained a public health threat, resulting in 32,000 to 51,000 U.S. deaths last fall and winter, according to CDC data.
Until now, the vaccinations had been routinely provided to nearly all Americans who wanted them. The Food and Drug Administration recently put new restrictions on this year’s shots from Pfizer, Moderna and Novavax, reserving them for people over 65 or younger ones who are deemed at higher risk from the virus.
Panelists declined to recommend the shots for anyone, including seniors and high-risk populations. They said individuals could make their own decisions. Removing the recommendations that were previously in place may confuse Americans trying to decide whether and how to get their fall boosters.
The panel also urged the CDC to adopt stronger language around claims of vaccine risks, despite pushback from outside medical groups who said the shots had a proven safety record from the billions of doses administered worldwide.
The divided panel narrowly avoided urging states to require a prescription for the shot.
Several states have announced policies to try to ensure people’s access to COVID-19 vaccines, worried about Friday’s ACIP decision. And a group representing most health insurers, America’s Health Insurance Plans, said earlier this week that its members will continue covering the shots through 2026.
Panel votes against MMRV shots for children under 4
The committee recommended that a combined vaccine known as MMRV should not be given to children under 4. Instead, they said in an 8-3 vote with one abstention, children in this age group should get separate vaccines — one for MMR and another for varicella, or chickenpox.
Their discussions centered on rare feverish seizures that can occur in kids who receive the first dose, between the ages of 1 and 2. Medical experts agree these seizures, while potentially frightening for families, are not linked to brain function or school problems.
In 2009, the ACIP changed a previous recommendation to advise that either the combination shot or separate shots were acceptable for the first dose.
Some doctors and public health experts say they are not aware of any new safety data that would explain the revisiting of those vaccination recommendations.
About 85% of children already receive separate doses for the first round, according to information presented at the meeting.
But experts have raised concerns that other kids could have a hard time getting the combination vaccine as a result of the panel’s recommendation. Government insurance programs like Medicaid, for example, would have to stop paying for the early combo dose if the acting CDC director accepts the panel’s guidance.
Group punts on hepatitis B vote amid criticism
Ever since the ACIP panel in 2005 recommended a dose of the hepatitis B vaccine for newborns, cases of the liver virus among infants have dropped by more than half.
Nonetheless, the committee opted to revisit the guidance in this week’s meeting, with members questioning whether babies born to moms who test negative for hepatitis B really need a vaccine at birth.
The panelists considered whether to recommend delaying that initial vaccination — something doctors and parents already can choose to do.
One committee member asked if the vaccination right after birth was “asking our babies to solve an adult problem.” Hepatitis B can spread through sex, sharing needles, or from an infected mother to a newborn baby.
But several outside medical experts criticized that the committee was debating the issue at all and said the vaccine is safe and successful at reducing infant infections.
After discussing it on Thursday, the panel decided Friday morning to indefinitely postpone a vote on the issue.
Differences from previous ACIP gatherings leave doctors concerned
Chairman Martin Kulldorff opened the meeting by challenging former CDC directors to a public debate. Several doctors representing outside medical groups accused the panel of not following the CDC’s long-established guidelines in weighing evidence for making recommendations.
CDC staff, as usual, presented numerous studies on the topics being debated, explaining how they chose which research to discuss. But a few times, panel members cited different papers they had found, including ones done in mice, which are not generally considered applicable.
The committee also took a vote on Thursday that they had to redo on Friday morning concerning the government’s Vaccines for Children program, which covers vaccine costs for about half of U.S. kids. On Friday, they voted to align coverage under the program with their guidance on MMRV shots. A day earlier, they had voted no on the idea.
“We are rookies. … There are many technical issues that we might not grasp as of yet,” Kulldorff said. He said a committee member had told him that “maybe we didn’t quite understand what was going on” with the vote.
At one point Thursday, one of the panelists appeared to be napping, with his eyes closed and his chin resting on his chest.
Doctors and public health experts watching the meeting unfold said they are concerned that the committee is creating fear and mistrust around vaccines at a time when U.S. vaccination rates are already falling.
They suggested the new panel was selectively using its recommendations to justify specific conclusions, rather than considering all the evidence.
“It’s troubling to see the erosion of the committee’s integrity,” said Dr. Sandra Fryhofer of the American Medical Association.
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Associated Press writer Jonathan Poet in Philadelphia contributed to this report.
