During a chaotic meeting, federal advisors cast a contentious 8-to-3 vote against recommending the combined measles, mumps, rubella, and chickenpox (M.M.R.V.) vaccine for children under four years old.
The session concluded abruptly without a decision on the standard Hepatitis B vaccine for newborns, a critical immunization that protects against a highly infectious liver disease. This vote has been rescheduled for the following day.
The committee’s inexperience was evident; many members, newly appointed by Health Secretary Robert F. Kennedy Jr., required basic explanations regarding meeting procedures, scientific study design, and how to identify flaws in presented data.
Adding to the disarray, panelists appeared uncertain about the core mission of the ‘Vaccines for Children’ program, which supplies free immunizations to nearly half of all American children. Approving vaccines for this program is one of the committee’s fundamental responsibilities.
Despite the controversy, rescinding the M.M.R.V. vaccine recommendation is not expected to have significant impact, as separate vaccines for measles, mumps, rubella, and chickenpox, which are more commonly administered, retain their current recommendations.
In a peculiar turn of events, the committee simultaneously voted 8-to-1 to keep the M.M.R.V. vaccine covered by the ‘Vaccines for Children’ program for the same age group, despite their earlier vote against recommending it. This contradictory decision left many questioning the members’ understanding, with three abstaining due to explicit confusion.
This initial vote signals what many fear will be the first of numerous alterations to the established schedule for routine childhood immunizations.
During extensive discussions, including presentations of scientific studies and emotional appeals from medical organizations, the committee appeared to favor limiting the Hepatitis B vaccine to newborns of infected mothers, delaying vaccination for all other infants until at least one month of age.
However, experts warn that such a restriction would endanger newborns. Many pregnant women carrying Hepatitis B are undetected due to missed routine testing, inaccurate results, or issues with reporting and interpretation, leaving their infants vulnerable.
Chari Cohen, President of the Hepatitis B Foundation, emphasized the difficulty of ensuring that all infected mothers are identified and that their newborns receive a birth dose, especially for those lacking prenatal care.
She warned that this policy would likely result in many vulnerable infants being missed, leading to a rise in new chronic Hepatitis B infections among newborns.
A separate vote concerning Covid-19 vaccine recommendations is also scheduled for the following day.
The Advisory Committee on Immunization Practices (ACIP), led by Chair Martin Kulldorff, announced the formation of two new work groups: one to examine vaccine use during pregnancy and another to review existing childhood and adolescent immunization schedules.
Public health experts are deeply concerned that the new administration’s potential changes to the childhood vaccine schedule, particularly restricting certain vaccines, could lead to a re-emergence of diseases long considered eradicated.
Dr. Sean O’Leary, chair of the infectious disease committee for the American Academy of Pediatrics, warned that limiting vaccine access would inevitably bring back serious childhood illnesses.
He stressed the heartbreaking reality that these nearly entirely preventable diseases could cause immense suffering for children and families once again.
The Childhood Vaccination Schedule Under Review
An interactive graphic illustrating the current CDC recommended vaccination schedule from birth through 16 years, highlighting the Hepatitis B, M.M.R.V., and Covid-19 vaccines which are currently under review by the advisory panel. It shows specific doses for each age group and provides annotations regarding particular vaccine usage and recommendations.
Introduced in 2005, the M.M.R.V. vaccine offers a combined alternative to two separate injections: the M.M.R. shot (for measles, mumps, rubella) and the varicella (chickenpox) vaccine.
During the meeting, CDC scientists presented data indicating a minor increase in fever-induced seizures associated with the M.M.R.V. combination vaccine. These seizures, also seen with common childhood illnesses like ear infections, are generally not linked to long-term harm.
The CDC has historically advised separate M.M.R. and chickenpox vaccinations for children under four due to this known, albeit small, seizure risk.
However, to reduce clinic visits and injections, pediatricians and parents often chose the combined M.M.R.V. shot. The panel’s recent decision aimed to remove this option.
This decision was met with strong opposition from various medical organizations.
Dr. Amy Middleman, from Case Western Reserve University and a liaison to the committee, noted that the M.M.R.V. discussion lacked the standard comprehensive presentations on feasibility, acceptability, cost-benefit analysis, or equity considerations.
Dr. Middleman strongly urged the committee to adhere to a rigorous, evidence-based process for public health recommendations, especially given the significant impact of their decisions.
Earlier, former CDC director Susan Monarez, who was removed after less than a month in her role, informed lawmakers that Health Secretary Kennedy Jr. had allegedly instructed her to approve all panel recommendations, irrespective of scientific backing.
Historically, the advisory panel’s recommendations have shaped state vaccine mandates and insurance coverage. However, its recent actions seem to have diminished its authority and credibility.
Following the committee’s initial June meeting, several prominent medical organizations ended their long-standing collaboration with the panel, choosing instead to issue their own independent vaccine recommendations.
Furthermore, most major insurers announced on Tuesday that they would continue covering routine immunizations through 2026, regardless of any restrictive votes from the panel. Senator Bill Cassidy, chairman of the Senate health committee, publicly advised Americans against trusting the panel’s revised childhood vaccine recommendations.
Internal tensions among the panelists were evident during the M.M.R.V. vaccine discussion.
Dr. Cody Meissner, a highly respected pediatrician and panelist from Dartmouth Geisel School of Medicine, expressed concern, stating that the committee’s actions implied a lack of trust in parents’ ability to make informed decisions.
He highlighted that a vote against the combination vaccine would effectively remove it as an option for families.
The majority of the current panelists are new appointments. In June, Mr. Kennedy controversially dismissed all 17 previous committee members, replacing them with seven new individuals, largely aligned with his vaccine-skeptical views. Another five members were added recently, a stark contrast to the usual rigorous, months-long vetting process for ACIP members.
During their inaugural June meeting, the initial seven new panelists declared their intent to re-examine all childhood and adolescent vaccinations. They also voted to revoke a long-standing recommendation for certain flu shots containing thimerosal, a preservative falsely linked to autism by anti-vaccine groups.
A planned revision to Hepatitis B vaccine recommendations was unexpectedly postponed until Friday due to a ‘small discrepancy’ in the vote’s wording, according to a Department of Health and Human Services spokesman, who declined to provide further details.
The Hepatitis B vaccine, typically administered to newborns within 24 hours of birth, is widely credited by public health experts for drastically reducing maternal transmission in the U.S., cutting annual cases from approximately 20,000 before 1991 to fewer than 20 today.
Untreated, Hepatitis B can cause severe liver damage, including cirrhosis, liver failure, and cancer. Infants infected at birth face a 90% risk of developing chronic Hepatitis B, with one in four experiencing severe complications or death.
Health Secretary Kennedy Jr. and his supporters maintain that Hepatitis B is solely transmitted through sexual contact or shared needles, suggesting that only infants of infected mothers require immunization at birth.
Dr. Noele Nelson, a key author of the existing Hepatitis B vaccine guidelines and former head of the CDC’s hepatitis vaccines work group, pointed out that a pregnant woman’s Hepatitis B status is not always reliably known.
She explained that infections can be missed due to inaccurate tests or issues with reporting and interpreting results.
Dr. Nelson emphasized that universal Hepatitis B vaccination at birth acts as a vital ‘safety net,’ protecting infants even if their mother’s infection status is unknown or misdiagnosed. Dr. Nelson resigned from the CDC in July.
Dr. James Campbell, vice chair of the American Academy of Pediatrics’ infectious disease committee, clarified that Hepatitis B, a highly contagious virus, can spread beyond sexual contact, including through shared household items like toothbrushes or razors.
He noted that past risk-based Hepatitis B vaccination approaches, targeting only infants of infected mothers, failed to significantly reduce the disease burden, hence the current universal recommendation.
Health Secretary Kennedy Jr. has publicly questioned the Hepatitis B vaccine’s safety, incorrectly claiming inadequate testing. During his January confirmation hearing, he notably refused to acknowledge the widely accepted scientific fact that the Hepatitis B vaccine does not cause autism.
Dr. Claudia Hawkins, a Hepatitis B and C specialist at Northwestern University Feinberg School of Medicine, affirmed the vaccine’s safety, stating there have been no reports of serious side effects in any age group since its introduction.
She concluded that there is no scientific basis to delay the Hepatitis B vaccine.