The federal advisory panel on immunizations experienced a tumultuous meeting on Thursday, concluding with an 8-to-3 vote against recommending a combined measles, mumps, rubella, and chickenpox (M.M.R.V.) vaccine for children under four years old. Adding to the disarray, a planned vote on the standard hepatitis B vaccine for newborns was postponed to Friday due to unresolved issues.
This committee has recently seen significant changes, with roughly half of its members appointed by Health Secretary Robert F. Kennedy Jr. just this week. The rapid formation of the panel was evident, as many new members required basic explanations of standard meeting procedures, scientific study design, and how to identify critical flaws in proposed data. A lack of understanding regarding the “Vaccines for Children” program, which supplies free immunizations to nearly half of all American children and is a primary focus of the committee’s approval process, was also apparent among panelists.
While the decision to withdraw the M.M.R.V. recommendation is unlikely to dramatically alter current vaccination practices, as separate vaccines for these diseases remain recommended and more commonly used, it signals a potential shift in official immunization guidance. Curiously, the panel later voted 8 to 1 to continue covering the M.M.R.V. vaccine for children under 4 through the Vaccines for Children program, a decision that left some members explicitly confused and abstaining.
This vote is just one of what is expected to be many revisions to routine immunization recommendations. During a lengthy discussion, committee members appeared to favor limiting the hepatitis B vaccine to newborns whose mothers are known to be infected, and to other infants only after they are at least one month old.
However, health experts caution that such a restriction could significantly elevate risks for newborns. Many pregnant women with hepatitis B infections are not identified due to missed testing, inaccurate results, or communication problems, despite routine testing recommendations. Chari Cohen, president of the Hepatitis B Foundation, warned that “many babies born to positive moms will be missed,” potentially leading to a rise in chronic hepatitis B infections among infants.
A separate vote on Covid-19 vaccine recommendations is also slated for Friday. Furthermore, the Advisory Committee on Immunization Practices (ACIP) chair, Martin Kulldorff, announced the formation of two new work groups: one to examine vaccine use during pregnancy and another to review the entire childhood and adolescent vaccination schedules.
Public health experts are deeply concerned that these administrative changes could lead to a rollback of crucial vaccination guidelines, fearing a resurgence of diseases that were once largely eradicated. Dr. Sean T. O’Leary of the American Academy of Pediatrics expressed distress, stating, “If people cannot access vaccines, we will see the return of diseases that once caused serious health issues for children.” He emphasized the heartbreak of seeing children suffer from preventable illnesses.
The childhood vaccination schedule table highlights the recommended ages for various vaccines, including those under review: Hepatitis B (at birth, 1 month, 6 months), MMRV (12 months, 4 years), and Covid-19 (starting at 6 months).
The M.M.R.V. vaccine, available since 2005, offers an alternative to separate shots for measles, mumps, rubella, and chickenpox. During Thursday’s meeting, CDC scientists presented data indicating a slight increase in fever-induced seizures with the combination vaccine. While these seizures are generally harmless and can occur with other common childhood illnesses, the CDC has historically recommended administering MMR and chickenpox shots separately for children under four due to this risk.
Despite this, some pediatricians and parents chose the M.M.R.V. option to minimize clinic visits and injections. The panel’s recent decision aimed to eliminate this choice. Medical organizations have strongly opposed the panel’s stance. Dr. Amy Middleman from Case Western Reserve University highlighted the absence of typical detailed presentations on feasibility, cost-benefit, and equity concerns during the M.M.R.V. discussion. She urged the committee to follow a more methodical, evidence-based process for public health decisions.
Adding to the controversy, Susan Monarez, a former CDC director who was removed after less than a month, reportedly stated that Secretary Kennedy instructed her to approve all panel recommendations irrespective of scientific evidence.
Historically, ACIP’s recommendations have guided state vaccine mandates and insurance coverage. However, recent decisions appear to have undermined its authority. Following the committee’s June meeting, several medical organizations broke ties with the panel to issue their own recommendations. Furthermore, most major insurers announced on Tuesday that they would continue to cover routine immunizations through 2026, regardless of the panel’s restrictive votes. Senator Bill Cassidy also advised Americans not to trust the panel’s revisions to childhood vaccine guidelines.
The M.M.R.V. debate exposed underlying tensions within the panel. Dr. H. Cody Meissner, a pediatrician and one of the most respected vaccine science experts on the panel, questioned the rationale, stating, “What we’re saying is, We don’t trust parents to make a decision.” He noted that voting against the combination vaccine would remove it as an option.
Many current panelists are new appointments. In June, Mr. Kennedy dismissed all 17 previous members and appointed seven new ones, largely aligned with his vaccine-skeptical views. Five more members were added this week. Typically, ACIP members undergo extensive vetting for months or years.
At their June meeting, the initial seven panelists declared their intent to scrutinize all recommended childhood and adolescent vaccinations. They also voted to revoke a longstanding recommendation for a small category of flu shots containing thimerosal, a preservative falsely linked to autism by many anti-vaccine advocates.
A close-up shot shows a hepatitis B vaccine being prepared for a 1-month-old patient.
The panel was also expected to revise hepatitis B recommendations on Thursday but deferred the decision to Friday due to a “small discrepancy” in the voting language, as per a Department of Health and Human Services spokesman. Neither he nor Dr. Kulldorff provided further details. The first dose of the hepatitis B vaccine is typically given to newborns within 24 hours of birth. This practice is widely credited by public health experts for nearly eradicating maternal transmission of the disease in the U.S., reducing cases from about 20,000 annually before 1991 to fewer than 20 today.
Untreated hepatitis B can severely damage the liver, leading to cirrhosis, liver failure, and cancer. Babies infected at birth face a 90% chance of developing chronic hepatitis B, with one in four experiencing severe complications or death.
Mr. Kennedy and his supporters have incorrectly asserted that hepatitis B is exclusively transmitted through sexual contact or shared needles, suggesting that only infants of infected mothers should be vaccinated at birth. However, Dr. Noele P. Nelson, a lead author of the current vaccine guidelines and former CDC hepatitis vaccines work group leader, explained that a pregnant woman’s hepatitis B status isn’t always known, and tests can yield inaccurate results. She emphasized, “Hepatitis B vaccination at birth for all newborns provides an effective safety net, ensuring that infants born to mothers with unknown or inaccurate infection status are protected.” Dr. Nelson resigned from the CDC in July.
Dr. James Campbell of the American Academy of Pediatrics further noted that hepatitis B can spread through other means, such as shared household items like toothbrushes. He recalled past risk-based vaccination recommendations that failed to control the disease burden, highlighting why universal recommendations are now in place.
Mr. Kennedy has falsely questioned the safety and testing protocols of the hepatitis B vaccine. During his confirmation hearing, he notably avoided confirming that the hepatitis B vaccine does not cause autism, a scientific consensus. However, Dr. Claudia A. Hawkins, a specialist in hepatitis B and C at Northwestern University, affirmed that hepatitis B vaccines are “very safe, with no reports of any serious side effects in babies, children or adults since their introduction,” and that “there is no reason to delay” their administration.