In a meeting that devolved into confusion and near chaos, federal advisers on Thursday voted 8 to 3 against vaccinating children under four years old with a combination shot that protects against measles, mumps, rubella and chickenpox.
The meeting ended without a planned vote on whether newborns should receive the vaccine against hepatitis B, a highly infectious disease that damages the liver, as is currently the standard. That vote was postponed until Friday.
In a sign of how hastily the committee was put together, the advisers — about half of whom were only appointed to the panel by Health Secretary Robert F. Kennedy Jr. earlier this week — needed explanations of the usual protocol for these meetings, the design of scientific studies and critical flaws in the data they suggested including.
The panelists also seemed unsure about the purpose of the Vaccines for Children program, which provides free shots to roughly half of all American children. Approving which vaccines the program should cover is a key function of the committee.
The decision to rescind the M.M.R.V. recommendation is unlikely to have widespread consequences. The recommendations for other vaccines given separately to protect against those diseases — the more common practice — remain unchanged.
In a bizarre twist, the members also voted 8 to 1 to have the Vaccines for Children program continue to cover the M.M.R.V. vaccine for children under 4. It was unclear whether the members all understood what they were voting for. Three members abstained altogether, one of them explicitly citing his confusion as the reason.
Still, the vote is likely to have yielded the first of many changes to the official recommendations for routine immunizations.
In an hourslong discussion that included the presentation of study findings and often passionate statements by outside representatives of medical organizations, the committee members seemed inclined to restrict the hepatitis B vaccine to newborns whose mothers are known to be infected, but only to other babies after they are at least one month old.
But experts said this would increase the risk to newborns. Many hepatitis B infections in pregnant women are missed, despite a longstanding recommendation to test them routinely. Infected women may also not be identified because of inaccurate results or because of problems reporting or interpreting the results.
“It will be challenging to identify all positive moms, and ensure that a birth dose is available to those infants in hospitals, especially for those who do not receive prenatal care,” said Chari Cohen, president of the Hepatitis B Foundation.
“So it is likely that many babies born to positive moms will be missed, we will likely see new chronic hepatitis B infections among some new babies.”
A separate vote on Covid vaccine recommendations is also scheduled for Friday.
The panel, the Advisory Committee on Immunization Practices, also established two new work groups, Martin Kulldorff, the panel’s chair, said on Thursday: one to analyze vaccine use in pregnancy, the other to review childhood and adolescent vaccination schedules.
That the new administration might make significant changes to the childhood vaccine schedule has alarmed many public health experts, who said they feared that restricting the use of certain vaccines would result in a resurgence of long-vanquished diseases.
“If people cannot access vaccines, we will see the return of diseases that once caused serious health issues for children,” said Dr. Sean O’Leary, chair of the infectious disease committee for the American Academy of Pediatrics.
“These diseases are now almost entirely preventable, and as a pediatrician it is heartbreaking to see a child and family suffer in this way,” he said.
The M.M.R.V. vaccine has been available since 2005. It is an alternative to administering two separate shots: the M.M.R. shot, against measles, mumps and rubella; and the shot that immunizes children against varicella, or chickenpox.
At the meeting on Thursday, scientists from the Centers for Disease Control and Prevention presented data showing that the combination vaccine slightly increases the risk of seizures caused by a fever. Such seizures also can occur with any childhood illness, including ear infections, but do not cause lasting harm.
The C.D.C. had long recommended administering the shots for M.M.R. and chickenpox separately in children under 4, because of the risk of seizures.
Still, pediatricians and parents sometimes opted for the combination M.M.R.V. shot to lessen the number of clinic visits and injections. The panel’s recommendation against the shot was intended to eliminate that choice.
Experts from other medical organizations objected vehemently to the panel’s decision.
The M.M.R.V. discussion on Thursday did not include the usual detailed presentations on the feasibility and acceptability of the decision, the cost-benefit ratio or equity concerns, said Dr. Amy Middleman, who heads pediatrics and adolescent medicine at Case Western Reserve University. She is a liaison to the committee from the Society for Adolescent Health and Medicine.
“I would urge the committee to follow the methodical process of an evidence-to-recommendation process before voting on something that affects the public health to this degree,” Dr. Middleman said.
On Wednesday, Susan Monarez, who was ousted from the C.D.C. after less than a month as its director, told lawmakers that Mr. Kennedy planned had directed her to approve every recommendation from the panel “regardless of the scientific evidence.”
The advisory panel’s decisions have typically guided state vaccine mandates. And insurance companies are required to cover any shot the panel recommends. But its recent decisions appear to have eroded its standing.
After the committee’s first meeting in June, several medical organizations broke their decades-long partnership with the panel to issue their own recommendations.
And on Tuesday, most major insurers said they would continue to cover routine shots through 2026, even if the panel voted to restrict their use. On Wednesday, Senator Bill Cassidy, Republican of Louisiana and chair of the Senate health committee, said Americans should not trust the panel’s moves to revise childhood vaccine recommendations.
The M.M.R.V. discussion revealed tensions among the panelists.
“What we’re saying is we don’t trust parents to make a decision,” said Dr. Cody Meissner, a pediatrician at the Dartmouth Geisel School of Medicine, widely considered to be the most qualified panelist on vaccine science and practice.
If the panel votes against the combination vaccine, the shot “won’t be an option,” he said.
Most of the panelists are first-time members. In June, Mr. Kennedy fired the 17 previous members of the committee, and appointed seven new members, most of whom generally agreed with his skeptical stance on vaccines. He announced another five members earlier this week. Members of A.C.I.P. are typically vetted for months to years before they are invited to join.
When the seven panelists met in June, they announced that they would scrutinize all the vaccinations recommended for children and adolescents. They also voted to rescind a longstanding recommendation for a small subset of flu shots that contain a preservative called thimerosal, which many anti-vaccine groups have falsely said causes autism.
The panelists were also expected to revise the recommendations for hepatitis B on Thursday but unexpectedly deferred the vote to Friday because of a “small discrepancy” in the language of the vote, according to a spokesman for The Department of Health and Human Services. Neither he nor Dr. Kulldorff would elaborate further.
The first dose of the vaccine is given to newborns within 24 hours of birth. The shot is credited by public health experts with nearly eliminating maternal transmission of the disease in the United States, slashing the incidence to fewer than 20 cases a year from about 20,000 a year before 1991.
Untreated hepatitis B can damage the liver, leading to cirrhosis, liver failure and liver cancer. Babies infected at birth have a 90 percent chance of developing chronic hepatitis B, and one in four of those children go on to have severe complications or die from the disease.
Mr. Kennedy and his allies have argued that hepatitis B is transmitted only through sexual contact or sharing needles and, therefore, only babies of infected women should be immunized at birth.
Dr. Noele Nelson, a senior author on the current guidelines for the vaccine and former leader of the C.D.C.’s hepatitis vaccines work group, said a pregnant woman’s hepatitis B status may not always be known.
An infection may also be missed if a test yields inaccurate results or because of problems reporting or interpreting the results, Dr. Nelson said.
“Hepatitis B vaccination at birth for all newborns provides an effective safety net,” she added, “ensuring that infants born to mothers with unknown or inaccurate infection status are protected.” Dr. Nelson resigned from the C.D.C. in July.
Hepatitis B, a highly contagious virus, can be spread in other ways besides sexual transmission, including by household objects that have been used by someone else, like toothbrushes, razors or combs, said Dr. James Campbell, the vice chair of the infectious disease committee for the American Academy of Pediatrics.
“We’ve had, in the past, risk-based hepatitis B vaccination recommendations, and they did not reduce the overall burden,” he said, referring to vaccinating only at birth when a mother is infected. “That’s why we have universal recommendation now.”
Mr. Kennedy has questioned the hepatitis B vaccine’s safety and has claimed, incorrectly, that it was not tested properly. In his confirmation hearing in January, he refused to say that the hepatitis B vaccine does not cause autism, a fact widely accepted among scientists.
But Dr. Claudia Hawkins, who cares for patients with hepatitis B and hepatitis C at Northwestern University Feinberg School of Medicine, said hepatitis B vaccines are “very safe, with no reports of any serious side effects in babies, children or adults since their introduction.”
“There is no reason to delay the hepatitis B vaccine,” she said.
Apoorva Mandavilli reports on science and global health for The Times, with a focus on infectious diseases and pandemics and the public health agencies that try to manage them.
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