Health Secretary Robert F. Kennedy Jr. is signaling a clear intent to overhaul the nation’s childhood vaccination guidelines. On Thursday, federal advisors seemed ready to vote against recommending a specific combination vaccine for children under four that protects against measles, mumps, rubella, and chickenpox.
While this particular decision may not drastically alter current vaccination practices — as separate shots for these diseases remain recommended and are more commonly used — it marks the beginning of potentially many changes proposed by the committee, whose members were handpicked by Mr. Kennedy.
Indeed, this upcoming vote is anticipated to be just the first step in a series of revisions to the country’s official immunization recommendations.
During Thursday’s meeting, Martin Kulldorff, chair of the Advisory Committee on Immunization Practices (ACIP), announced the formation of two new work groups. One will delve into vaccine usage during pregnancy, while the other will undertake a comprehensive review of existing childhood and adolescent vaccination schedules.
This development has sparked considerable concern among many public health experts. They worry that any restrictions on established vaccine use could lead to the alarming return of diseases that were once largely eradicated.
Furthermore, the committee is expected to vote on restricting the hepatitis B vaccine. This crucial immunization, which protects against a highly infectious liver-damaging disease, may only be recommended for newborns whose mothers are confirmed carriers or for infants at least one month old.
Dr. Sean O’Leary, who chairs the infectious disease committee for the American Academy of Pediatrics, warned, “If people cannot easily get vaccinated, we risk seeing a comeback of diseases that once severely impacted children’s health.”
He emphasized the gravity of the situation, stating, “These diseases are largely preventable today, and as a pediatrician, witnessing a child and family endure such suffering is truly heartbreaking.”
The current childhood vaccination schedule is under review by the C.D.C.’s immunization advisory panel, with three recommended shots for children under 18 highlighted for potential changes. These include the Hepatitis B shot at birth, one month, and six months; the combined measles, mumps, rubella, and chickenpox (MMRV) shot at 12 months and four years; and the Covid-19 shot starting at six months.
The MMRV vaccine, introduced in 2005, offers a single injection alternative to the separate measles, mumps, rubella (MMR) vaccine and the chickenpox (varicella) vaccine.
Panel members had already indicated in their inaugural June meeting that the MMRV shot would be a significant point of examination.
During Thursday’s session, Centers for Disease Control and Prevention (CDC) scientists presented data suggesting a marginal increase in fever-induced seizure risk with the combination vaccine. It’s important to note that such seizures, while alarming, are also possible with common childhood illnesses like ear infections and typically cause no long-term damage.
Historically, the CDC has advised giving the MMR and chickenpox vaccines separately to children under four due to this recognized, albeit small, seizure risk.
Despite this, many pediatricians and parents chose the combined MMRV vaccine for its convenience, reducing the number of clinic visits and injections. The panel’s impending vote aims to remove this option altogether.
This proposed recommendation to discontinue the MMRV vaccine has met with strong opposition from other major medical organizations.
Dr. Amy Middleman, head of pediatrics and adolescent medicine at Case Western Reserve University and a liaison to the committee, noted that Thursday’s MMRV discussion lacked critical presentations on the decision’s practicality, public acceptance, cost-benefit analysis, and equity implications.
A decision against the MMRV vaccine would have significant implications for vaccine access, as it would cease to be covered by programs like Vaccines for Children and the Children’s Health Insurance Program, which together serve approximately half of the nation’s youth.
Dr. Middleman strongly urged the committee to adhere to a thorough, evidence-based recommendation process before making any votes that could so profoundly impact public health.
Adding to the controversy, Susan Monarez, who was removed from her role as CDC director after less than a month, informed lawmakers on Wednesday that Mr. Kennedy intended to revise the childhood immunization schedule.
Monarez claimed Mr. Kennedy instructed her to approve all panel recommendations, “regardless of the scientific evidence” presented.
Historically, the advisory panel’s recommendations have been foundational for state vaccine mandates, and insurers are typically required to cover recommended shots. However, recent decisions by the committee seem to have undermined its authority and credibility.
Following the committee’s initial meeting in June, several prominent medical organizations ended their long-standing collaboration with the panel, opting instead to issue their own vaccination guidelines.
In a notable development, most major insurers announced Tuesday that they would continue to cover routine immunizations through 2026, irrespective of any restrictive votes by the panel. Senator Bill Cassidy, chair of the Senate health committee, further advised Americans on Wednesday to distrust the panel’s proposed revisions to childhood vaccine recommendations.
The MMRV discussion clearly highlighted underlying tensions among the committee members.
Dr. Cody Meissner, a pediatrician from Dartmouth Geisel School of Medicine and a highly respected voice in vaccine science, expressed his concern: “What we are essentially communicating is a lack of trust in parents to make informed decisions.”
He emphasized that if the panel votes against the combination vaccine, it would effectively remove it as an option for families.
The current panel is largely composed of new appointees. In June, Mr. Kennedy controversially dismissed all 17 previous committee members, replacing them with seven individuals largely aligned with his skeptical views on vaccines. He added another five members just this week. Traditionally, ACIP members undergo a rigorous vetting process spanning months to years before their appointment.
At their June gathering, the original seven new panelists declared their intention to scrutinize all recommended childhood and adolescent vaccinations. They also voted to reverse a long-standing recommendation for certain flu shots containing thimerosal, a preservative that has been incorrectly linked to autism by many anti-vaccine groups.
Beyond MMRV, the panel is also poised to revise hepatitis B vaccine recommendations. This vaccine, typically given to newborns within 24 hours, is widely recognized by public health experts for its success in nearly eradicating maternal transmission of the disease in the U.S., dramatically reducing cases from approximately 20,000 annually before 1991 to fewer than 20 today.
Untreated hepatitis B poses severe health risks, including liver damage, cirrhosis, liver failure, and liver cancer. Alarmingly, babies infected at birth face a 90 percent chance of developing chronic hepatitis B, with one in four of these children experiencing severe complications or succumbing to the disease.
However, Mr. Kennedy and his supporters contend that hepatitis B transmission is limited to sexual contact or sharing needles, suggesting that only infants born to infected mothers require immunization at birth.
Dr. Noele Nelson, a lead author of the vaccine’s current guidelines and former head of the CDC’s hepatitis vaccines work group, highlighted a critical flaw in this argument: a pregnant woman’s hepatitis B status isn’t always readily apparent or accurately known.
She further explained that infections can be overlooked due to inaccurate test results or issues with reporting and interpretation.
Dr. Nelson, who resigned from the CDC in July, concluded, “Universal hepatitis B vaccination at birth acts as an essential safety net, safeguarding infants even when their mothers’ infection status is unknown or misdiagnosed.”
Dr. James Campbell, vice chair of the infectious disease committee for the American Academy of Pediatrics, clarified that hepatitis B, a highly contagious virus, can spread beyond sexual contact, including through shared household items like toothbrushes, razors, or combs.
He recalled previous risk-based vaccination strategies for hepatitis B, noting, “In the past, vaccinating only at birth when a mother was infected proved ineffective in reducing the overall disease burden. This is precisely why universal vaccination became the standard recommendation.”
Mr. Kennedy has openly challenged the safety of the hepatitis B vaccine, incorrectly asserting that it lacked proper testing. During his January confirmation hearing, he notably refrained from affirming the scientific consensus that the vaccine does not cause autism.
However, Dr. Claudia Hawkins, a specialist in hepatitis B and C at Northwestern University Feinberg School of Medicine, countered, stating that hepatitis B vaccines are “exceptionally safe, with no reported serious side effects in any age group since their inception.”
She unequivocally affirmed, “There is absolutely no valid reason to postpone the hepatitis B vaccine.”
A separate vote concerning Covid-19 vaccines is slated for Friday.