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Here in the U .S., we have a vaccine schedule.
So in childhood, as you may know, there's a slate of routine vaccines to protect against hepatitis B or measles, mumps, and rubella.
And this continues into adulthood.
Think COVID boosters and the flu shot.
Now, that schedule is driven by recommendations of a special committee within the Centers for Disease Control and Prevention, known as ACIP, or the Advisory Committee on Immunization Practices.
And in June, there was a major shakeup to business as usual and the very makeup of this group.
My coworker, public health correspondent Ping Wong, has been following all of these developments.
Hey. Hey, Emily. Yeah.
Secretary of Health Robert F.
Kennedy Jr. fired all 17 members of ACIP a few weeks ago and he replaced them with seven new members, many of whom do not have deep expertise in vaccines.
Some of them have spread vaccine misinformation.
Dr. Sean O 'Leary at the American Academy of Pediatrics told our colleague Maria Godoy that he did not have faith in this new group.
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.
And in response to this, a spokesperson for the Department of Health and Human Services told NPR, quote, Secretary Kennedy has replaced vaccine group think with a diversity of viewpoints.
So the new ACIP held their first meeting in Atlanta, Georgia, Wednesday and Thursday of last week.
Ping, what was your high -level takeaway having watched it?
I mean, Emily, I've been to a lot of these meetings, and this one was a huge departure from how they usually go.
The committee promised sweeping changes to how vaccine policy is made in the U .S., and they resurrected issues that have been advanced in groups that question vaccines.
What's clear is that these new members will be steering vaccine policy to a very different place.
Today on the show, how a newly reimagined committee may drive the direction of vaccines in the U .S. for years to come.
You're listening to Shortwave, the science podcast from NPR.
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Thank you. Okay, Ping, so before we start, let's talk about why this committee is so important, ACIP.
They do not approve vaccines.
That's the job of the FDA.
But this group does shape how vaccines get distributed.
How does that work?
Okay, you mentioned the vaccine schedule.
So if the CDC approves a recommendation that ACIP makes, it becomes policy and it gets put into the official vaccine schedule for children and for adults, depending on what the recommendation is.
Insurers also have to pay for it.
So under the Affordable Care Act, health insurers are required to cover all ACAP -recommended vaccines.
And critically, their votes also determine what's in the Vaccines for Children program.
What's that? Yeah, so that's a federally funded initiative that provides free access to vaccines for low -income, under -insured children.
Around half of the kids in the U .S. are eligible for free vaccines from this program.
So it sounds like the committee really drives vaccine access in the U .S., making them available and free.
Right, right. They drive access and they also make recommendations for what all of us should and shouldn't be getting at what age and when.
So this group is very important, even if it's an acronym that most Americans have not heard. Who are the new members of ACIP?
OK. So initially, Kennedy named eight new people to the committee, but one of them dropped out before the meeting during the review for financial conflicts of interest. So now there's seven members.
Some of them rose to prominence in recent years by spreading misinformation about vaccines and specifically COVID vaccines.
All of them came to this meeting mostly in person, although there were two that were remote.
And were you watching remotely?
Were you in the room?
I was in the room where it was all happening.
I was sitting in this press row, you know, watching the committee members and the CDC presenters and everyone else that was there very intently.
Okay, so folks from the CDC are presenting to this group.
That's interesting.
What happened? Okay.
So the meeting looked normal from the outside and probably even to anyone who was just watching for the first time on the YouTube stream.
There were presentations, there were discussions, there were votes, but the conversations that they were actually having were very different.
So, for instance, I'm going to bring you into a discussion they had about the annual flu vaccine.
It started like it usually does with CDC staff presenting data for the last flu season.
And, Emily, the flu season we just had was really bad.
According to the CDC, they saw the highest rate of people being hospitalized for flu in more than a decade.
And also, 250 children died with influenza -related illness, which is the most they've seen since they first started tracking this 20 years ago.
The response from new member Dr. Robert Malone was it didn't seem like such a big deal.
The 250 pediatric deaths, which is, let's acknowledge, is a modest number.
And then the committee started quite a serious discussion about thimerosal in flu vaccines.
So thimerosal is a vaccine preservative that's rarely used in vaccines these days.
And back in the mid to late 1990s, there were theories that it could be a cause of autism in children.
But that claim has long been disproven.
And even so, vaccine manufacturers voluntarily removed it from most childhood vaccines.
So, again, it's used really infrequently today, and there hasn't been much new research on it for years.
Okay, so they're talking about the flu vaccine.
Thimerosal comes up.
What happens then? Yeah, and thimerosal actually more than came up.
It was a scheduled agenda item for a vote.
The new committee chair, Martin Kulldorff, said that the committee was reopening topics like thimerosal to increase public trust in vaccines.
Typically, the presentations at these meetings come from CDC experts.
But Kulldorff also said that this new committee is open to all types of expertise.
So they got a presentation on this from Lynn Redwood, who's the former president of Children's Health Defense.
What's her background?
Is she a scientist?
scientist? So she is not a PhD or an MD, but she has led the group that Kennedy founded and chaired.
And this is a group that's advocated against vaccines and spread misinformation about them.
Okay. So then what happened?
So then the committee voted on, you know, what types of flu vaccines they would recommend.
And while they all agreed that people should continue to get annual flu vaccines, the majority voted to limit the recommendation to the versions of the vaccines without thimerosal.
Dr. Cody Meissner, who's a pediatrics professor at Dartmouth, he was the only one who objected.
All vaccines that are routinely recommended for young children in the United States are available in formulations that do not contain thimerosal as a preservative.
Of all the issues that I think ACIP needs to focus on, this is not a big issue.
He also said, And Emily, in past ACIP meetings, this lack of evidence would usually just put an end to the discussion.
They would table it, they would get more information, and they'd come back to it later.
But this time, it actually sparked speculation and new recommendations.
Interesting. Okay, so they took a vote on thimerosal.
all. There was also a vote on a product that protects babies against RSV or respiratory syncytial virus.
How did that vote go?
Okay. So this vote was actually less controversial, but it still went very strangely.
One of the new members, Retsef Levy, who's a professor at the MIT Sloan School of Management, he kept wondering out loud whether the product was killing babies, even though the CDC, the people who presented the studies, and other Other members of the committee were all telling him there was no reason to think this.
And then when the vote came up, Levy was one of two people to vote no. Dr. Levy?
I vote no. I just want to clarify that my objection is based on the fact that I don't feel this is ready to be administered to all healthy babies.
I think we should take a more precautionary approach to this.
But minutes later, when the same product came up for the Vaccines for Children program, Levy voted yes.
Dr. Levy? Rets of Levy, I don't have any conflicts of interest. I think that we need to ensure access, so whatever kids need to actually use that product, of course, I think we need to make sure that they get it, so yes.
So the Vaccines for Children resolution is like an add -on to the main vote.
People usually vote the same way because it's essentially the same question.
Yeah, that makes sense.
but he voted differently.
So what do you make of that, Ping?
Yeah, I mean, I'm not quite sure myself, you know, and it wasn't just Levy.
There was also Vicky Pebsworth, who's volunteer director of research and patient safety at the National Vaccine Information Center.
This is a group that argues for vaccine exemptions, recently called on the FDA to stop recommending mRNA COVID shots for anyone.
And Pebsworth also voted no on the first RSV question and then yes to put the same product in the Vaccines for Children program.
So let's move on to some work groups that have emerged.
And I know we're getting into the nitty gritty of this committee.
Not that I meant to rhyme, but this is how the sausage gets made.
This is how vaccine schedules get decided.
So there's a work group that plans to look at the vaccine schedule for kids.
Tell me about that.
Yeah. And Emily, you're absolutely right that work groups are, you know, how the sausage gets made in this situation.
You know, work groups are like big multi -year endeavors where committee members along with of CDC staff and other people who are stakeholders in this process meet quite regularly for a long time and review all this data, funnel it down so that by the time it actually gets presented in a public meeting, it's pretty clear.
So at this meeting, Kuhldorf, the chair, announced that they were starting work groups with an eye towards possibly decreasing the number of shots that kids get.
So that was one work group that he mentioned.
He also mentioned a separate work group that was was going to look into vaccines that had not been reviewed in more than seven years.
Also with a possible eye of deciding whether or not they were still necessary or needed or whether the timing around them should be changed.
And it confirmed a lot of fears that people in the public health community have had since Kennedy became health secretary.
So already he's announced that he's removing universal recommendations for kids and pregnant women to get COVID vaccines.
This was a change he made without the committee's input.
And now he shifted the makeup of the committee away from people with deep expertise in vaccines to people who come with a lot of skepticism, even on issues that have long been considered settled.
After the meeting wrapped in Atlanta, what did folks not on the committee say, people who work in public health?
Yeah. So the president of the Infectious Diseases Society of America, Tina Tan, called the meeting politicized, chaotic, and not transparent, said it was harmful to the American people, and also that it'll drive down vaccine confidence overall.
Wow. And she and the IDSA are not alone in the sentiment.
My colleague Will Stone and I have been covering reactions to this news.
Many types of health experts, from infectious disease experts to physicians to pediatricians, shared similar concerns.
You know, for instance, the American Academy of Pediatrics actually boycotted this meeting, decided not to attend, even though they usually do.
And Dr. Jim Campbell, who's with the AAP, said they thought there would be no room for real participation and that the votes on thimerosal we discussed earlier proved that.
The vote was based on a single talk without any work group or other expert input.
That is not the way that ACIP typically works, so we're just disappointed that that's the direction that it's taken.
And the meeting has raised big questions about the future of vaccine policy for Dr. Andy Pavia, a pediatrician at the University of Utah.
I think hundreds of physicians, epidemiologists, pediatricians watched with some degree of horror.
Pavia also pointed out that this is a panel that helps shape insurance coverage for vaccines.
And he's worried that what they decide going forward is actually going to reduce access to them for many, many people.
well ping thank you for this reporting and for your insights it is so appreciated i really appreciate you as well emily i love meetings and this one is a particularly important one yes short ravers if you don't already please follow us on the npr app or wherever you listen to podcasts your support truly helps our show this episode was produced by hannah chin it was edited by scott hensley and our showrunner rebecca ramirez tyler jones and rebecca ramirez check the facts.
The audio engineer was Kweisi Lee.
Beth Donovan is our senior director and Colin Campbell is our senior vice president of podcasting strategy.
I'm Emily Kwong. Thanks for listening to Shorewave from NPR.
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