A recent gathering of federal health advisors quickly became disorganized and confusing. During this chaotic meeting, the panel voted 8 to 3 to no longer recommend a combined vaccine for children under four years old. This particular shot protects against measles, mumps, rubella, and chickenpox (MMRV).
The session concluded without addressing a crucial decision regarding the hepatitis B vaccine for newborns. Currently, it’s standard practice for infants to receive this shot to guard against the highly infectious, liver-damaging disease. The vote on this matter has been deferred until Friday.
Roughly half of the committee members were recent appointees by Health Secretary Robert F. Kennedy Jr., highlighting the rushed nature of the panel’s formation. Many new members reportedly struggled with understanding standard meeting procedures, basic scientific study designs, and even fundamental errors in the data they proposed to consider.
Many of the panelists also appeared uncertain about the purpose of the Vaccines for Children program, which supplies free vaccinations to approximately half of all American children. A primary role of this committee is to approve which vaccines should be covered by this vital program.
The decision to rescind the M.M.R.V. recommendation is unlikely to have widespread consequences. Recommendations for other vaccines administered separately to protect against these diseases—a more common practice—remain unchanged.
In a bizarre turn, members also voted 8 to 1 to maintain coverage of the M.M.R.V. vaccine for children under four within the Vaccines for Children program. It was unclear whether all members fully grasped the implications of this vote. Three members abstained, with one explicitly stating confusion as their reason.
Nevertheless, this vote is expected to be the first of many modifications to the official guidelines for routine immunizations.
During an extensive discussion, committee members seemed inclined to limit the hepatitis B vaccine to newborns whose mothers are confirmed to be infected, and to other infants only after they reach at least one month of age.
However, experts warned that such a restriction would elevate the risk for newborns. Many hepatitis B infections in pregnant women are missed, despite a long-standing recommendation for routine testing. Infected women might also go unidentified due to inaccurate test results or difficulties in reporting or interpreting them.
“It will be challenging to identify all positive moms, and ensure that a birth dose is available to those infants in hospitals, especially for those who do not receive prenatal care,” explained Chari Cohen, president of the Hepatitis B Foundation.
“So it is likely that many babies born to positive moms will be missed,” she added. “We will likely see new chronic hepatitis B infections among some new babies.”
A separate vote on Covid vaccine recommendations is also slated for Friday.
The panel, known as the Advisory Committee on Immunization Practices (ACIP), also established two new work groups, according to its chair, Martin Kulldorff: one to examine vaccine use during pregnancy and another to review existing childhood and adolescent vaccination schedules.
The prospect of the new administration making significant alterations to the childhood vaccine schedule has caused alarm among many public health experts. They fear that restricting access to certain vaccines could lead to a resurgence of diseases that were once largely eradicated.
“If people cannot access vaccines, we will see the return of diseases that once caused serious health issues for children,” stated Dr. Sean T. O’Leary, chair of the infectious diseases committee for the American Academy of Pediatrics.
“These diseases are now almost entirely preventable, and as a pediatrician it is heartbreaking to see a child and family suffer in this way,” he concluded.
The childhood vaccination schedule
The C.D.C.’s immunization advisory panel will review three of the recommended shots for children under 18.
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The M.M.R.V. vaccine has been available since 2005. It is an alternative to administering two separate shots: the M.M.R. shot, against measles, mumps and rubella; and the shot that immunizes children against varicella, or chickenpox.
At the meeting on Thursday, scientists from the Centers for Disease Control and Prevention presented data showing that the combination vaccine slightly increases the risk of seizures caused by a fever. Such seizures also can occur with any childhood illness, including ear infections, but do not cause lasting harm.
For years, the CDC has advised giving the MMR and chickenpox vaccines as separate shots to children under four. This recommendation was based on a known, albeit small, increased risk of fever-induced seizures with the combination vaccine.
Still, pediatricians and parents sometimes opted for the combination M.M.R.V. shot to lessen the number of clinic visits and injections. The panel’s recommendation against the shot was intended to eliminate that choice.
Experts from other medical organizations objected vehemently to the panel’s decision.
The M.M.R.V. discussion on Thursday did not include the usual detailed presentations on the feasibility and acceptability of the decision, the cost-benefit ratio or equity concerns, said Dr. Amy Middleman, who heads pediatrics and adolescent medicine at Case Western Reserve University. She is a liaison to the committee from the Society for Adolescent Health and Medicine.
“I would urge the committee to follow the methodical process of an evidence-to-recommendation process before voting on something that affects the public health to this degree,” Dr. Middleman said.
On Wednesday, Susan Monarez, who was ousted from the C.D.C. after less than a month as its director, informed lawmakers that Mr. Kennedy had instructed her to approve every recommendation from the panel “regardless of the scientific evidence.”
The advisory panel’s decisions have typically guided state vaccine mandates. And insurance companies are required to cover any shot the panel recommends. But its recent decisions appear to have eroded its standing.
After the committee’s first meeting in June, several medical organizations broke their decades-long partnership with the panel to issue their own recommendations.
And on Tuesday, most major insurers said they would continue to cover routine shots through 2026, even if the panel voted to restrict their use. On Wednesday, Senator Bill Cassidy, Republican of Louisiana and chair of the Senate health committee, stated that Americans should not trust the panel’s moves to revise childhood vaccine recommendations.
The M.M.R.V. discussion highlighted underlying tensions among the panelists.
“What we’re saying is, We don’t trust parents to make a decision,” observed Dr. H. Cody Meissner, a pediatrician at the Dartmouth Geisel School of Medicine, who is widely considered the most qualified panelist on vaccine science and practice.
If the panel votes against the combination vaccine, the shot “won’t be an option,” he pointed out.
Most of the panelists are first-time members. In June, Mr. Kennedy dismissed all 17 previous members of the committee and appointed seven new individuals, most of whom generally aligned with his skeptical views on vaccines. He announced another five members earlier this week. Traditionally, ACIP members undergo months, sometimes years, of vetting before being invited to join.
When the seven panelists first convened in June, they declared their intention to meticulously examine all vaccinations recommended for children and adolescents. They also voted to revoke a long-standing recommendation for a small subset of flu shots containing thimerosal, a preservative that many anti-vaccine groups have incorrectly linked to autism.
The panelists were also expected to revise the recommendations for hepatitis B on Thursday. However, they postponed the decision until Friday due to a “small discrepancy” in the wording of the vote, according to a spokesman for the Department of Health and Human Services. Neither he nor Dr. Kulldorff provided further details.
The initial dose of the hepatitis B vaccine is typically administered to newborns within 24 hours of birth. Public health experts credit this shot with virtually eradicating maternal transmission of the disease in the United States, reducing the incidence from approximately 20,000 cases annually before 1991 to fewer than 20 cases a year.
Untreated hepatitis B can severely damage the liver, potentially leading to cirrhosis, liver failure, and liver cancer. Babies infected at birth face a 90 percent chance of developing chronic hepatitis B, and one in four of these children will experience severe complications or die from the disease.
Mr. Kennedy and his supporters have asserted that hepatitis B is exclusively transmitted through sexual contact or shared needles, and therefore, only infants born to infected mothers should receive the vaccine at birth.
Dr. Noele P. Nelson, a lead author on the current guidelines for the vaccine and a former head of the CDC’s hepatitis vaccines work group, noted that a pregnant woman’s hepatitis B status is not always known.
An infection might also be missed if a test yields inaccurate results, she added.
“Hepatitis B vaccination at birth for all newborns provides an effective safety net,” she explained, “ensuring that infants born to mothers with unknown or inaccurate infection status are protected.” Dr. Nelson resigned from the CDC in July.
Hepatitis B, a highly contagious virus, can spread through various means beyond sexual transmission, including household objects shared with an infected person, such as toothbrushes, razors, or combs, explained Dr. James Campbell, vice chair of the infectious disease committee for the American Academy of Pediatrics.
“We’ve had, in the past, risk-based hepatitis B vaccination recommendations, and they did not reduce the overall burden,” he emphasized, referring to the practice of vaccinating only at birth when a mother is infected. “That’s why we have universal recommendation now.”
Mr. Kennedy has questioned the safety of the hepatitis B vaccine, incorrectly asserting that it was not adequately tested. During his confirmation hearing in January, he declined to state that the hepatitis B vaccine does not cause autism, a fact widely accepted by the scientific community.
However, Dr. Claudia A. Hawkins, who treats patients with hepatitis B and C at Northwestern University’s Feinberg School of Medicine, affirmed that hepatitis B vaccines are “very safe, with no reports of any serious side effects in babies, children or adults since their introduction.”
“There is no reason to delay the hepatitis B vaccine,” she concluded.
Correction: An earlier version of this article misstated the date that AHIP, the national trade association representing the health insurance industry, said health plans would continue to cover all immunizations recommended as of Sept. 1. It was Tuesday, Sept. 16, not Wednesday.