A group of medical experts that advise the CDC largely determine which vaccines people should receive, what gets covered by insurance and which shots are made available free of charge to millions of low-income children.
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Joe Raedle/Getty Images
Until this week, it’s likely many people hadn’t heard much about the Centers for Disease Control and Prevention’s vaccine advisory panel.
But the Advisory Committee on Immunization Practices, or ACIP, plays a key role in determining which vaccines children and adults receive, what gets covered by insurance and which shots are made available free of charge to millions of low-income children. So the panel’s decisions ultimately affect the health of all Americans.
Health Secretary Robert F. Kennedy Jr. took the unprecedented step of dismissing all 17 members of the panel on Monday. Two days later, he announced the names of eight of the people he has chosen to replace them.
Several of Kennedy’s new selections for the panel rose to prominence during the COVID-19 pandemic, when they criticized government policies on school closures and lockdowns, and the mRNA vaccines. One, Vicky Pebsworth, has served on the board of the National Vaccine Information Center — an advocacy group that warns against vaccine risks.
Some immunization and infectious disease specialists worry that the newly constituted committee is skeptical of vaccines and could vote to downgrade the importance of some shots, and ultimately make it more difficult for families to get them.
“I am very concerned,” says Dr. Walter Orenstein, who served as director of the U.S. immunization program at the CDC from 1988 to 2004 and is now professor emeritus of infectious diseases at Emory University School of Medicine. “I have spent a career of more than 50 years in vaccinology, and I have never seen the names of most of those people.”
Dr. Sean O’Leary, chair of the Committee on Infectious Diseases for the American Academy of Pediatrics, calls the changes to ACIP a “disaster.”
“Imagine if you took all the air traffic controllers in the U.S. and just fired them and you replaced them with people that not only didn’t really know how to be air traffic controllers, but several of them didn’t even believe in flying,” he says.
In a statement, HHS defended Kennedy’s choices for the committee, saying they are “highly credentialed doctors, scientists, and public health experts committed to evidence-based medicine, gold standard science, and common sense.”
The statement said that the group “will demand definitive safety and efficacy data for any new vaccine recommendations,” and that they will review the current vaccine schedule.
Recommendations that affect insurance coverage
The members of ACIP meet at least three times a year to sift through the scientific data on vaccines and determine which ones are recommended for different age groups. If the CDC approves ACIP’s recommendations, that can lead to a vaccine becoming part of the official immunization schedule for children and adults.
It also means insurance has to pay for it. Under the Affordable Care Act, health insurers are required to cover all ACIP-recommended vaccines.
ACIP’s recommendations also determine which vaccines get covered by the Vaccines for Children program, a federally funded initiative that provides free access to low-income and underinsured children. Around half of all children in the U.S. are eligible for free vaccines from the program, says Orenstein.
That means any changes to the vaccines recommended by ACIP “would be a major potential barrier to access for vaccines for a substantial proportion of the children in this country if they took it from a vaccine off of the schedule,” Orenstein says.
He helped launch the Vaccines for Children program in the aftermath of a huge measles resurgence from 1989 to 1991 that resulted in tens of thousands of cases and over 120 deaths. Many of the kids who got sick had not been vaccinated because their families couldn’t afford it.
ACIP’s recommendations often help guide which immunizations are required for school entry.
Guidance that influences how doctors practice
The wording of the committee’s recommendations matters too. A routine recommendation calls for all people within a given age or risk group to get a specific vaccine, unless there is a medical reason not to. But ACIP can also choose to recommend a vaccine under what’s called shared clinical decision-making – which means a doctor and a patient decide together if it makes sense.
“Generally, we don’t really like shared clinical decision-making because it makes it less of a priority for clinicians to talk to their patients about a vaccine,” says Dr. Michelle Fiscus, a pediatrician and chief medical officer for the Association of Immunization Managers.
It also makes it harder to have a clear, direct conversation with families, says O’Leary, of the American Academy of Pediatrics, who is also a professor of pediatrics at the University of Colorado School of Medicine.
“What I’ve heard anecdotally from pediatricians is, what [families will] say is, well, you guys are the experts. If you can’t figure out what the right thing to do is, you know, how do you expect us to do that in a ten-minute office visit?” O’Leary says.
That designation can also make it less likely that a medical provider will keep a vaccine in stock, he says. O’Leary notes that most pediatricians and many other health care providers in the U.S. participate in the Vaccines for Children program and are required to keep routinely recommended vaccines in stock. But that’s not the case when a vaccine is recommended under shared clinical-decision making.
“Already it’s very challenging for a lot of mostly family medicine physicians in rural areas to stock vaccines because it financially is very challenging for them,” O’Leary says.
He says recommending a vaccine under shared clinical decision-making could potentially make it less available, especially in rural areas.
The CDC’s recently changed the recommendations on COVID vaccines for children to shared clinical decision-making, and O’Leary says that has already sown confusion among parents and pediatricians alike. He worries that, if the new ACIP moves more vaccines to that designation, it will “sow distrust in the process.”
“It makes it look like these vaccines aren’t important and these vaccines are very important. They save lives every day,” he says.
