The tumultuous atmosphere that marred the federal vaccine committee’s initial day, following appointments by Health Secretary Robert F. Kennedy Jr., persisted into its second session. The panel retracted a previous decision and once again put off a crucial vote on a hepatitis B vaccine, highlighting ongoing disarray.
Friday morning saw the committee vote against federal funding coverage for a combination vaccine targeting measles, mumps, rubella, and chickenpox. This decision overturned their own vote from Thursday, which had initially approved coverage, seemingly due to a misinterpretation of the proposal’s wording by some members.
Furthermore, panelists expressed reservations about making a definitive decision on restricting the hepatitis B vaccine, commonly administered to all newborns. Some voiced lingering concerns regarding the vaccine’s safety, while others appreciated the committee’s caution, viewing it as a safeguard against potentially harmful hasty choices for children.
Dr. Joseph Hibbeln, a neuroscientist previously with the National Institutes of Health, articulated this sentiment, stating, “We are more prudent when we are cautious,” as he cast his vote to postpone the decision.
The previous day’s session concluded with visible discord among the panel members. A live microphone inadvertently captured one member referring to another as “an idiot,” though the speaker’s identity remained unconfirmed.
Similarly, Friday’s proceedings occasionally descended into heated exchanges and pointed comments. Dr. Jason Goldman, representing the American College of Physicians as a committee liaison, directly accused Chairman Martin Kulldorff of silencing him during discussions.
Dr. Goldman challenged, “You advocate for debate and discussion, yet you’re silencing and muting individuals. If you could transparently explain to the public how these vaccine decisions will be analyzed, the committee could truly earn our confidence.”
Chairman Kulldorff responded sharply, “You’ve raised that point previously, and I addressed it in a very polite and civil way.”
The committee’s pronouncements carry significant weight, as most private insurers are obligated to cover recommended vaccines, and numerous state immunization policies align directly with its guidelines. This influence extends even to vaccines not explicitly recommended, which insurers might still opt to cover.
It appeared that some members shared Mr. Kennedy’s ambition for drastic changes to standard childhood immunization schedules. For years, Mr. Kennedy has asserted, without scientific backing, that children are over-vaccinated and that current vaccines lack adequate testing.
The evident indecisiveness among the panelists underscored the hasty manner in which Mr. Kennedy had formed the committee. Many members were new to their roles, and their lack of experience seemingly contributed to the widespread confusion throughout the meeting. Roughly half of the committee had only been appointed days prior to the session.
During Thursday’s session, the committee initially voted to revoke the M.M.R.V. vaccine’s recommendation for children under four. A separate vote concerned the continued funding of this vaccine by the ‘Vaccines for Children’ program, which serves approximately half of American children. Despite an affirmative vote on Thursday, this decision was remarkably overturned in a subsequent vote on Friday.
This stark contradiction marked an unprecedented event for the Advisory Committee on Immunization Practices, as did the unusual step of redoing the vote the very next day.
While approving vaccine coverage is a core responsibility of the committee, it became clear that some members did not fully grasp the implications of their votes. On Thursday, multiple members admitted to being unsure of what they were voting on, with one abstaining entirely due to this confusion.
The panelists themselves seemed acutely aware of the unfavorable public perception generated by these proceedings.
Acknowledging the situation on Friday, Dr. Kulldorff stated that while the panelists possess “enormous depth and knowledge” regarding vaccines, they are effectively “rookies” in navigating the established decision-making protocols of the A.C.I.P. committee.
This situation stems from a significant overhaul in June, when Mr. Kennedy dismissed all 17 incumbent committee members. He then appointed seven new individuals, many of whom share his skeptical views on vaccines, followed by an additional five appointments earlier this week. Traditionally, A.C.I.P. members undergo a rigorous vetting process that can span months or even years before their invitation to join.
Leading medical organizations sharply condemned the committee’s departure from established A.C.I.P. methodologies, which typically involve thorough discussions on feasibility, acceptability, cost-benefit analysis, and crucial equity considerations.
Dr. Amy Middleman, head of pediatrics and adolescent medicine at Case Western Reserve University and a liaison from the Society for Adolescent Health and Medicine, observed that panelists were “distracted” by minor studies presenting safety concerns, rather than adhering to comprehensive evaluation methods.
She emphasized that while all vaccines and drugs inherently carry risks, the committee’s fundamental scientific role is to meticulously assess whether the benefits demonstrably outweigh those risks.
Public health specialists dedicated to hepatitis B research expressed relief and satisfaction at the committee’s decision to postpone the vote on the hepatitis B vaccine.
Dr. Noele P. Nelson, a lead author of the vaccine’s current guidelines and former head of the C.D.C.’s hepatitis vaccines work group, remarked, “Tabling the vote is both appropriate and a relief.”
She further added that “this discussion should not be rushed and would greatly benefit from a more comprehensive evaluation of its potential public health impact.”
Traditionally, newborns receive the hepatitis B immunization within 24 hours of birth. The committee was set to consider a proposal to recommend the vaccine only for infants whose mothers were confirmed carriers, with other babies receiving the shot no earlier than one month of age.
Experts in hepatitis B highlighted the vaccine’s success in almost eradicating maternal transmission of the disease in the U.S. They noted a dramatic reduction from approximately 20,000 cases annually before 1991 to fewer than 20 cases per year currently.
They warned that delaying the initial vaccine dose would heighten risks for newborns, as many cases of hepatitis B in pregnant women go undetected, even with routine testing recommendations.
Furthermore, some infected women might not be identified due to inaccurate test results or difficulties in reporting or interpreting those results.
Dr. John W. Ward, director of the Coalition for Global Hepatitis Elimination and former head of the C.D.C.’s viral hepatitis division, asserted, “A universal birth dose recommendation is the sole method to guarantee that all newborns exposed to this virus are vaccinated, especially those whose mothers were not screened during pregnancy.”
Hepatitis B experts also expressed skepticism regarding the panel’s singular focus on vaccine safety, given decades of data from millions of infants confirming the vaccine’s safety. This narrow focus also contributed to discontent among some committee members regarding the quality of the discussion.
Voicing frustration, Dr. Hibbeln noted on Thursday that the debate around potential harms of the hepatitis B vaccine was drifting into “speculation,” emphasizing, “We need data on real risks and benefits.”
Later on Friday, the committee was scheduled to vote on Covid-19 vaccines, with expectations leaning towards restricting access to these immunizations.