In a significant development, Health Secretary Robert F. Kennedy Jr.’s efforts to reshape the national childhood vaccination schedule are becoming clearer. Federal advisors, during their Thursday meeting, seemed ready to vote against recommending the combined measles, mumps, rubella, and chickenpox (MMRV) vaccine for children under four. This decision marks a pivotal moment, though the standard recommendations for the individual shots against these diseases remain unchanged.
This vote is anticipated to be just the first in a series of modifications to the official routine immunization recommendations. The Advisory Committee on Immunization Practices (ACIP) plans to establish two new working groups: one to focus on vaccine use during pregnancy and another to re-evaluate childhood and adolescent vaccination schedules, as announced by the panel’s chair, Martin Kulldorff.
This proposed overhaul has deeply concerned many public health experts, who warn that restricting access to certain vaccines could lead to the re-emergence of diseases that were once largely eradicated. The committee is also expected to vote on limiting the use of the hepatitis B vaccine, a highly contagious disease that can severely damage the liver.
Dr. Martin Kulldorff, chair of the Advisory Committee on Immunization Practices, during the meeting in Atlanta on Thursday.
The proposed change for the hepatitis B vaccine would see it administered only to newborns whose mothers are known to be infected, and to other babies who are at least one month old.
“If people cannot access vaccines, we will see the return of diseases that once caused serious health issues for children,” warned Dr. Sean O’Leary, chair of the infectious disease committee for the American Academy of Pediatrics. He emphasized the heartbreak of seeing children suffer from preventable diseases, calling the current situation a step backward.
The MMRV vaccine, available since 2005, offers an alternative to two separate injections for measles, mumps, rubella, and chickenpox. The panel’s June meeting had already indicated that this combined shot was under close examination.
During Thursday’s session, scientists from the Centers for Disease Control and Prevention (CDC) presented data suggesting that the MMRV combination vaccine slightly elevates the risk of fever-induced seizures. While these seizures are generally harmless and can occur with common childhood illnesses like ear infections, the CDC had previously advised against the combined shot for children under four due to this risk. The panel’s impending vote aims to remove the MMRV shot as an option entirely.
Medical organizations have strongly opposed the committee’s proposal to remove the vaccine. Dr. Amy Middleman, head of pediatrics and adolescent medicine at Case Western Reserve University and a liaison to the committee, noted that the discussion lacked crucial presentations on feasibility, cost-benefit analysis, and equity concerns. She urged the committee to adhere to a methodical, evidence-based process before making decisions with such broad public health implications.
A hepatitis B shot being prepared for a 1-month-old patient in Pittsburgh.
Discontinuing the recommendation for the MMRV vaccine would mean it would no longer be covered by programs like Vaccines for Children or the Children’s Health Insurance Program, which serve a significant portion of the nation’s children. Susan Monarez, who was briefly the CDC director before being ousted, testified to lawmakers on Wednesday that Secretary Kennedy intended to revise the entire childhood immunization schedule and had instructed her to approve all panel recommendations regardless of scientific evidence.
ACIP’s decisions traditionally guide state vaccine mandates and insurance coverage. However, the panel’s recent actions have reportedly undermined its credibility. Following its initial meeting in June, several medical organizations ended their long-standing partnerships with the panel and began issuing their own recommendations. Furthermore, most major insurers announced on Tuesday that they would continue to cover routine vaccinations through 2026, irrespective of the panel’s decisions. Senator Bill Cassidy, chair of the Senate health committee, also publicly stated that Americans should not trust the panel’s new recommendations.
The debate over the MMRV vaccine highlighted internal tensions within the panel. “What we’re saying is we don’t trust parents to make a decision,” commented Dr. Cody Meissner, a pediatrician from the Dartmouth Geisel School of Medicine and a highly respected panelist on vaccine science. He pointed out that if the panel votes against the combination vaccine, parents would lose that choice.
Robert Malone, a member of the Advisory Committee on Immunization Practices, spoke during a meeting on June 25 in Atlanta.
Most of the current panelists are new appointments. In June, Mr. Kennedy dismissed the 17 previous committee members and appointed seven new ones, many of whom share his skeptical views on vaccines. He added another five members just this week. Traditionally, ACIP members undergo months, sometimes years, of vetting before their appointment. In June, the new panelists declared their intention to scrutinize all recommended childhood and adolescent vaccinations. They also voted to revoke a long-standing recommendation for specific flu shots containing thimerosal, a preservative falsely linked to autism by many anti-vaccine groups.
Further revisions are anticipated for the hepatitis B vaccine on Thursday. The current practice of giving the first dose to newborns within 24 hours of birth has been crucial in virtually eliminating maternal transmission of the disease in the U.S., reducing cases from approximately 20,000 annually before 1991 to fewer than 20 today.
Untreated hepatitis B can lead to severe liver damage, including 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 sexually or through shared needles, suggesting that only infants of infected mothers need immunization at birth.
Dr. Noele Nelson, a lead author of the current hepatitis B vaccine guidelines and former head of the CDC’s hepatitis vaccines work group, explained that a pregnant woman’s hepatitis B status isn’t always known or accurately reported. She stressed that “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, vice chair of the infectious disease committee for the American Academy of Pediatrics, further clarified that hepatitis B can spread through non-sexual household contact, such as sharing toothbrushes or razors. He added that past risk-based vaccination recommendations failed to reduce the overall disease burden, hence the shift to universal vaccination.
Mr. Kennedy has publicly questioned the hepatitis B vaccine’s safety and incorrectly claimed it wasn’t properly tested. During his January confirmation hearing, he notably refused to affirm that the hepatitis B vaccine does not cause autism, a scientific consensus. However, Dr. Claudia Hawkins, a specialist in hepatitis B and C at Northwestern University 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.” She concluded, “There is no reason to delay the hepatitis B vaccine.”
A separate vote regarding Covid vaccines is scheduled for Friday.