The U.S. health secretary’s dismissal of an influential vaccine advisory committee this week sowed uncertainty about the future of vaccine recommendations nationwide.
On Wednesday, Secretary Robert F. Kennedy Jr. announced eight new members of the Advisory Committee on Immunization Practices, which makes recommendations that are adopted by doctors, pharmacists, insurers and patients. His nominations included a physician who previously served on the committee, a scientist who has spread unfounded claims about Covid-19 vaccines and an epidemiologist who denounced Covid lockdowns.
Mr. Kennedy’s decision to overhaul the committee raised concerns among some medical experts, given his history of vaccine skepticism.
For decades, ACIP has been a “very important system to ensuring the health and safety of the country,” said Dr. Nancy Bennett, an emeritus professor of medicine and public health sciences at the University of Rochester School of Medicine and Dentistry and a former chair of the committee. “It’s hard to know what this huge disruption in the system will cause in the future,” Dr. Bennett said.
How does the committee shape vaccine policy?
Since 1964, ACIP has issued recommendations on the use of new and existing vaccines. ACIP usually meets three times a year, in discussions that are open to the public.
The committee’s voting members, who are medical experts with significant expertise in vaccines, virology and public health, are typically appointed by the health secretary for four-year terms. (The committee also has one consumer representative with an understanding of the social and community aspects of vaccination programs.) The group discusses and votes on key questions about vaccines, such as who should receive Covid boosters or at what ages children should receive certain shots.
ACIP reviews vaccines that have first been approved by the Food and Drug Administration, which reviews products for safety and efficacy.
To make its recommendations, the committee reviews data from vaccine manufacturers, research and vaccine safety data from the Centers for Disease Control and Prevention, and comments from the public. ACIP also considers how serious a disease is from a public health perspective, and how essential it is to vaccinate against it, Dr. Bennett said.
“We’re trying to prevent as much needless suffering and premature death as we can,” said Dr. Paul Hunter, a family physician in Madison, Wis., who previously served on ACIP. “What’s the best way to do that? What’s the best science for that? What’s the best practical way to implement that? What’s the most cost-effective way to do that?”
The committee presents its recommendations to the C.D.C. director. Historically, the C.D.C. has adopted most of ACIP’s recommendations, though the C.D.C. director has overruled the committee in rare cases.
Will I still be able to get vaccines if ACIP does not recommend them?
If the F.D.A. has approved a vaccine, then people who are eligible for the shot should still be able to get it.
Many insurers, including Medicare, are required to fully pay for the vaccines recommended by ACIP. If the new committee stops recommending a vaccine, people may have to pay for the shot out of pocket, said Jennifer Kates, a senior vice president at the nonprofit health organization KFF.
The Vaccines for Children Program, a federal initiative that provides free vaccines for children whose parents cannot afford them, automatically covers the costs of any shot that is recommended by ACIP and the C.D.C. Roughly half of U.S. children are eligible to get vaccines through the program, according to the C.D.C.
“All kinds of other smart people can recommend it, your doctor can recommend it, you can want it, but you may not be able to pay for it,” said Dr. Arthur Reingold, a professor of epidemiology at the University of California, Berkeley School of Public Health who has served on ACIP.
Where do I get reliable information about vaccines?
Doctors recommend speaking with your physician about the benefits and risks of vaccines and looking for guidance from groups like the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists, which regularly review evidence and issue their own statements and recommendations. In the past, that guidance has largely aligned with ACIP’s recommendations. (The New York Times has a list of other recommendations for sources of accurate health information.)
Dr. Walter Orenstein, an emeritus professor at Emory University and former director of the National Immunization Program at the C.D.C., said that reliable guidance about vaccines is essential for preventing misinformation that could affect vaccine uptake and lead to a further rise in preventable diseases.
What happens next?
ACIP has up to 19 voting members. It isn’t clear if or when Mr. Kennedy will announce others. The committee is scheduled to meet from June 25 to June 27. A previously released agenda said the committee would discuss vaccines against Covid, human papillomavirus and Lyme disease, among other topics.
Dani Blum is a health reporter for The Times.
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