The US Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices (ACIP) held a tense meeting Thursday, shaping potential shifts in longstanding vaccine policies.
The group, now appointed largely by US Health and Human Services Secretary Robert F. Kennedy Jr., delivered a split decision on vaccines for children, rejecting one widely used option while postponing another critical vote.
One of the most significant outcomes was the committee’s 8–3 vote against recommending the combined measles, mumps, rubella and varicella (MMRV) vaccine for children younger than age 4. Instead, members said children should receive the measles, mumps and rubella (MMR) shot separately from the varicella (chickenpox) vaccine. Dr. Joseph R. Hibbeln, Dr. Hillary Blackburn and Dr. Cody Meissner voted no, while Dr. Robert Malone abstained, citing conflicts of interest.
However, the committee voted against changing the recommendation for the Vaccines for Children (VFC) program, which ensures vaccine access for low-income families. This means children who receive vaccines through the federal program can still choose between a single MMRV shot or two separate injections. That vote carried 8 against changes, 1 in favor, and 3 abstentions, including Meissner, who admitted confusion over the process.
The ACIP’s decisions are not final. The Department of Health and Human Services noted it will “examine all insurance coverage implications” before any final adoption by Acting CDC Director Jim O’Neill. The committee itself has seen rapid turnover: Kennedy removed all 17 members earlier this year and replaced most with his own picks, reshaping how recommendations are debated and made.
Thursday’s actions have drawn criticism from experts. Dr. Jason Goldman, president of the American College of Physicians and a non-voting liaison, said the votes erode trust in science-based decision-making. “They are taking away the freedom of choice of individuals to decide with their physician what is best for their health care,” Goldman said.
Currently, parents of one-year-olds can opt for either a single MMRV dose or two separate vaccines. While clinical studies show the MMRV shot nearly doubles the risk of febrile seizures after high fevers, the absolute risk remains small: about 4.3 cases per 10,000 doses. In 2009, ACIP recommended MMR and varicella be given separately for first doses but allowed parents the choice. Roughly 85% of families now follow that guidance, while 15% still opt for the combined shot.
Some ACIP members questioned why the guidance was revisited without new data. “This discussion is really déjà vu for me,” said Meissner, a pediatrician who previously served on the committee. “No new safety concerns have been identified.” Dr. Amy Middleman, attending as a representative for adolescent health, echoed the sentiment, questioning the urgency.
While the MMRV debate stirred controversy, the most anticipated vote of the session – on whether newborns should continue receiving the hepatitis B vaccine shortly after birth – was delayed until Friday. Since 1991, the CDC has recommended infants be vaccinated within 24 hours of delivery, a move that slashed hepatitis B infections among babies from 18,000 annually to just about 20 cases.
Hepatitis B, a highly contagious virus that can be transmitted through small amounts of blood and other bodily fluids, poses long-term health risks. Up to 90% of infected infants develop chronic infections, often leading to liver cancer, scarring, or transplants later in life. One in four children infected will die prematurely.
The debate centers on whether babies born to mothers who test negative for hepatitis B need immediate vaccination or can wait until they are one month old. Kennedy himself has questioned the policy, framing it as unnecessary for newborns. But medical experts argue that delaying even a few weeks leaves infants vulnerable, especially since hepatitis B can spread through shared household items or contact with undetected carriers.
Dr. Hibbeln warned that assuming only mothers are the source of transmission overlooks broader risks. “The most prudent thing would be to vaccinate and protect as many people as possible,” he said. Others, like Dr. Evelyn Griffin, argued that informed consent should play a larger role, but Hibbeln countered that many mothers are unaware of their hepatitis B status.
Critics said changing the guidance would ignore decades of progress. “This still misses the most highly vulnerable window for protection of infants,” said Dr. Ravi Jhaveri, chief of pediatric infectious diseases at Lurie Children’s Hospital in Chicago.
Beyond the vaccine votes, Thursday’s meeting carried political overtones. New ACIP chair Martin Kulldorff, a Swedish epidemiologist known for his opposition to certain Covid-19 restrictions, opened by inviting nine former CDC directors to a public debate on vaccines. The move followed a New York Times op-ed by those officials criticizing Kennedy’s reshaping of the CDC and warning of risks to public health.
Kulldorff defended the committee, saying its goal was to “reassure the public and restore confidence by removing unnecessary risks.” He rejected claims of being anti-vaccine, insisting, “That is a pro-vaccine agenda.” Still, his framing of scientific disagreements as public debates drew rebukes. Former acting CDC director Dr. Richard Besser responded, “ACIP should not be reduced to political theater or gamesmanship. Lives are at stake.”
The ACIP will reconvene Friday to resume the hepatitis B debate and take up another contentious issue: Covid-19 vaccines for all age groups. With Kennedy’s influence shaping the membership and agenda, many public health leaders fear these meetings could redefine US vaccine policy in ways that undermine decades of science-backed progress.
As one health official put it, while Thursday’s votes may seem like tweaks to established policy, they could be “the beginning of the end” of public confidence in the process.
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