Advisory Committee on Immunization Practices Chair Martin Kulldorff — a doctor and former Harvard Medical School professor who is known for his opposition to vaccine mandates — speaks at the CDC’s ACIP panel on Sept. 18. Maya Homan/Georgia Recorder
ATLANTA — A key vaccine advisory panel at the Centers for Disease Control and Prevention voted to change its recommendations around certain childhood immunizations Thursday, despite the CDC’s own data showing that the vaccines are safe and effective.
The panel, known as the Advisory Committee on Immunization Practices, is charged with setting national guidelines around which people should be vaccinated against a wide range of preventable diseases and when those vaccines should be administered. The recommendations also play a key role in determining which vaccines are covered by insurance companies and how accessible immunizations are for the general public.
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All 12 current members of the committee were recently appointed by U.S. Health Secretary Robert F. Kennedy Jr., who abruptly dismissed the panel’s previous members and replaced them with hand-picked appointees, many of whom are seen as vaccine skeptics.
During his opening remarks, ACIP Chair Martin Kulldorff — a doctor and former Harvard Medical School professor who is known for his opposition to vaccine mandates — announced that the panel will be establishing new working groups to study the impact of vaccines on pregnant women and review childhood vaccine schedules, suggesting that ACIP plans to revisit other widely accepted vaccine policies.
The committee’s actions this week are also being closely watched after former CDC Director Susan Monarez was abruptly fired last month after 29 days on the job. She testified Wednesday before a U.S. Senate committee that she was dismissed because she would not pre-approve ACIP’s vaccine recommendations or fire career officials for no reason.
ACIP restricts use of MMRV vaccine
In the first of two votes on Thursday, the panel moved 8-3 to change its official recommendations around a combined immunization for measles, mumps, rubella and varicella, which is more commonly known as chickenpox. The MMRV vaccine, which has been used since 2005 to reduce the number of injections that children receive and improve vaccine compliance, will now be recommended only for children ages 4 and older.
Dr. Robert Malone, a biochemist who has previously said he views the label of anti-vaxxer as “high praise,” declined to vote, citing a conflict of interest with the vaccine manufacturer Merck.
The changes to the MMRV vaccine recommendations were made in response to data indicating that young children who receive the combined vaccine have a slightly increased risk of febrile seizures — or harmless convulsions in young children caused by a fever. However, according to CDC data, febrile seizures as a result of the MMRV vaccine were rare, occurring in about eight out of every 10,000 doses administered.
Only a small percentage of young children in the U.S. — about 15% — receive the combined MMRV vaccine as a first dose. The remaining 85% receive separate MMR and varicella vaccines for their initial dose. The majority of American children — or roughly 75% of them — receive a combined MMRV vaccine for their second dose, administered to those who are 4-6 years of age.
Certain ACIP members, including Dr. Cody Meissner, a professor of pediatrics and medicine at Dartmouth College who has served as a past committee member, criticized the focus on febrile seizures, which he said are generally not linked to vaccines and generally do not cause lasting harm to children who experience them.
“Every pediatrician is experienced in febrile seizures, and we know that the prognosis is excellent,” Meissner said, adding that the main concern doctors have around febrile seizures “is the anxiety it generates among the family members, and that’s entirely understandable, and it’s a very frightening experience. But I think people are very comfortable in saying that a febrile seizure is not associated with any sort of impaired performance or neurocognitive development.”
Doctors will now be required to administer the two vaccines separately for all children under 4 years of age, a move that experts say would not restrict vaccine access but may reduce uptake of one or both of the vaccines, particularly for children who have missed vaccine appointments in the past.
Kulldorf defended the decision to limit use of the MMRV vaccine, arguing that it would help restore trust in public health measures.
“I think trust and safety go hand in hand,” he told reporters after the vote. “The fewer adverse reactions we have, the more trust there will be in the vaccine schedule. So in my view, by giving MMR plus V instead of MMRV, there’s less adverse reactions, and that will lead to more trust.”
But in an unexpected twist, committee members voted 8-1 to allow the Vaccines for Children program — which provides free vaccines to children who are uninsured or underinsured — to continue using the old guidelines. That move imposes different requirements, though, for this federal program and others run through the Centers for Medicare and Medicaid Services.
“HHS will examine all insurance coverage implications following today’s ACIP recommendation, prior to a final decision on adoption by the Acting Director,” the agency said in a press release following the meeting.
Three members abstained from the vote on updating the Vaccines for Children rules, citing concerns about having different requirements in place for different government programs.
“I don’t want discrepancy between the children who get their vaccine from VFC and the children who don’t get their vaccine through VFC,” Meissner, who abstained from voting, told the panel. “That’s not right.”
Upcoming votes scheduled on hepatitis B, COVID-19
The panel is set to meet again Friday, where committee members are scheduled to discuss updated recommendations for childhood hepatitis B vaccines and COVID-19 shots among adults. A set of votes on hepatitis B recommendations was initially schedule for Thursday, but postponed shortly before the end of the day.
The panel may choose to remove a recommendation that all newborn babies get vaccinated against hepatitis B, an incurable viral infection that attacks the liver and can cause lifelong impacts. The current three-dose series for infants includes one hepatitis B immunization administered within 24 hours of birth, and subsequent booster shots given a month and six months after the initial dose. ACIP has been recommending hepatitis B vaccine at birth for all babies since 1991.
If the revised recommendations take effect, official CDC guidelines will advise pediatricians to delay administering the first dose of the hepatitis B vaccine until 30 days after birth for all children whose mothers test negative for the disease. Parents will still have the option to vaccinate their children before one month of age, but a dose immediately after being born will no longer be the default option.
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The panel is also scheduled to address updating vaccine guidelines for healthy adults at Friday’s meeting. In August, the U.S. Food and Drug Administration, which is tasked with overseeing vaccine development, approved a new round of COVID-19 vaccines, but limited eligibility for the updated shots to only those who are 65 or older, as well as younger people with certain health problems. Several states — including Georgia, where the CDC is based — are waiting for the committee to deliver its updated guidelines before deciding how widely available this year’s shot should be for the general public.
And in the absence of a federal consensus, states have begun to develop their own vaccine policies. California, Oregon, Hawaii and Washington state recently formed a group called the West Coast Health Alliance, which began issuing its own recommendations Wednesday. Florida, on the other hand, has announced plans to eliminate vaccine mandates altogether.
Noel Brewer, a professor of public health at the University of North Carolina and former member of ACIP who served for a year before being fired by Kennedy in June, says that medical organizations like the American Academy of Pediatrics are increasingly withdrawing from ACIP and forming their own vaccine recommendations in response to shifting federal immunization policies.
“Those are looked to by physicians, by doctors, as being the most authoritative word of the matter,” Brewer said. “ACIP is no longer that.”
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