The federal vaccine committee appointed by Health Secretary Robert F. Kennedy Jr. voted unanimously on Friday to further limit access to Covid vaccines, recommending that adults 65 and older receive the shots only after discussing the potential benefits and risks with a health care provider.
The panel also said that everyone from 6 months to 64 years old could get the vaccine after consulting with a provider. But it was unclear whether that contradicted the Food and Drug Administration’s authorization of the shots only for adults over 65 and younger people with certain health conditions.
Together, the decisions raise questions about whether Americans can continue to walk into their neighborhood pharmacies for routine vaccinations or whether in some states they will first need a doctor’s permission.
The votes came on the second meeting day of a committee that was hurriedly assembled by Mr. Kennedy. Most of the panelists are first-time members, and their inexperience seemed to contribute to the confusion that marred both days of the meeting. About half of the committee members were appointed to the panel earlier this week.
The recommendations approved by the panel, called the Advisory Committee on Immunization Practices, were less restrictive than many had expected. But they will still make it more difficult for pharmacists in some states to administer the shots to older adults. About two-thirds of Americans received last year’s Covid vaccine at a pharmacy or a drugstore.
“We think that it’s appropriate to bring it to something that is being discussed between a physician or medical provider and a patient,” said Retsef Levi, the committee member who led the Covid work group and presented the proposed votes.
The nation is no longer in an “emergency situation,” he said.
Mr. Kennedy had already restricted access to the vaccine for healthy pregnant women and healthy children. The Food and Drug Administration authorized this year’s Covid shot only for adults 65 and older or for other adults with certain medical conditions.
The panel also unanimously voted to recommend that the Centers for Disease Control and Prevention describe the risks of Covid vaccines to patients and health care providers. Providers are already legally required to provide patients with a sheet explaining the risks and benefits.
But the committee stopped short of approving a recommendation that would also have required Americans to have a prescription for the vaccines. That proposal elicited the strongest disagreement among the panelists, with some members noting that a significant percentage of Americans, particularly those living in rural areas, do not have access to a health care provider. It did not pass.
Most of the committee members have publicly opposed Covid vaccines or vaccine mandates, so their decision to limit access to the shots was not entirely surprising.
But the language and the specifics of the restrictions alarmed some public health experts.
“There will be preventable deaths that result from these decisions,” said Dr. Lakshmi Panagiotakopoulos, who oversaw the C.D.C.’s work group on the Covid vaccine before she resigned in June.
“Having people without vaccine and clinical expertise having the power to harm so much of the public is unbearable,” she said, referring to the panelists.
The chaos from the first day of the meeting bled into the second day, as the panel first voted in the morning session not to allow a federal vaccine program to cover the cost of a combination vaccine that protects against measles, mumps, rubella and varicella, or chickenpox.
This reversed a vote it had cast on Thursday to allow the coverage, apparently because some members had misunderstood the way it was worded.
Then the panel voted to postpone indefinitely a vote on a vaccine for hepatitis B that is typically given to all newborns. Panelists said they felt unready to decide whether to limit the use of the shot.
Some said they still had questions about the vaccine’s safety, while others seemed relieved that the panel did not make what they saw as a rash decision that might harm children.
“We are more prudent when we are cautious,” Dr. Joseph Hibbeln, a neuroscientist formerly at the National Institutes of Health, said as he voted to table the question.
Thursday’s session ended with the panel members at odds. A hot microphone caught one panelist calling another committee member “an idiot,” although it was unclear who was speaking.
Friday’s session, too, at times devolved into raised voices and sharp remarks. Dr. Jason Goldman, a liaison to the committee from the American College of Physicians, accused the committee’s chairman, Martin Kulldorff, of muzzling him.
“You want debate and discussion, but you’re muting people and silencing them,” Dr. Goldman said. “If you could respectfully tell the public how you are going to be analyzing all of these vaccine decisions, we can have confidence in this committee.”
Dr. Kulldorff retorted: “You made that comment before, and I responded to that comment in a very nice and polite manner.”
The Covid vote followed a contentious and sharply polarized debate, with many committee members questioning the safety and effectiveness of the shots.
During a discussion about whether the vaccine provided protection from the virus, Dr. Natalie Thornburg, who leads a respiratory division at the C.D.C., said the antibodies produced in response to the vaccines were believed to be protective.
But one of the panelists, Robert Malone, said there was no clear evidence to indicate the level of antibodies needed for protection.
“You really have no right to assert what your feelings or opinions are about whether or not there’s a correlation between any of these outcomes,” Dr. Malone said. “There is no established correlative protection for Covid period, full stop, and stop saying otherwise.”
Dr. Fiona Havers, who resigned from the C.D.C. in June, after Mr. Kennedy fired all 17 of the previous A.C.I.P. members, said she was dismayed by the exchange. Dr. Havers has often presented at A.C.I.P. meetings.
“I was shocked at how Robert Malone spoke to Dr. Thornburg, a well-respected leading scientist at C.D.C.,” Dr. Havers said. “That level of disdain for her expertise and lack of professionalism would not have been tolerated during A.C.I.P. meetings in the past.”
Some outside experts also were taken aback.
“It was disheartening to witness continued personal attacks on scientists during the A.C.I.P. meeting rather than sticking to the data, the end goal, the health and well being of the American people,” said Dr. Anne Zink, a public health expert at Yale University and the former chief medical officer of Alaska.
In his presentation, Dr. Levi, who led the Covid work group, said that assessments of the effectiveness of the vaccines were “based on very low-quality data and analyses” and that vaccine injuries were “demonstrably not recognized.”
(His slides were not available on the agency’s website, as is the norm, but a health department spokesman made them available to reporters during Dr. Levi’s talk.)
C.D.C. staff members and representatives of major medical organizations, including the American Medical Association, and other experts were united in their agreement that the vaccines are safe and effective.
“Or, if we don’t want to say effective, they work,” said Dr. Henry Bernstein, a member of the Covid work group.
“Shared clinical decision making and the need for a provider prescription create unnecessary steps to receiving a vaccine, and do not effectively target those that are at high risk,” he said.
The Covid vaccines, developed largely through Operation Warp Speed, were a triumph of the first Trump administration, prompting some lawmakers and others to propose that President Trump be awarded a Nobel Peace Prize.
Mr. Kennedy agreed in a recent Senate hearing that the president deserved the honor. But he has also called the Covid vaccine the “deadliest” shot ever made. He has maintained for years that children get too many shots, and has falsely claimed that the vaccines in use today were never properly tested.
On Thursday, the committee also voted to rescind an endorsement of the M.M.R.V. vaccine for children under 4. But in a related vote, they said the Vaccines for Children program, which provides immunizations to about half of all American children, should continue to cover the cost of the shot.
Such a contradiction was a first for the panel, as was the decision to redo that vote on Friday.
Approving which shots the vaccine program should cover is a key function of the committee, but some members did not appear to know that.
Several members said on Thursday that it was unclear what they were voting for. One explicitly abstained from the vote, citing his confusion as the reason.
The members themselves seemed uncomfortably aware of the optics.
The panelists have “enormous depth and knowledge” about vaccines, but are “rookies” when it comes to the ways in which the committee typically makes decisions, Dr. Kulldorff acknowledged on Friday.
Some medical organizations sharply criticized the committee’s bypassing the methods the A.C.I.P. typically follows, with detailed discussions on the feasibility and acceptability of the decisions, the cost-benefit ratio and equity concerns.
Instead, the panelists were “distracted” by small studies that raised safety concerns, said Dr. Amy Middleman, the head of pediatrics and adolescent medicine at Case Western Reserve University. She is a liaison to the panel from the Society for Adolescent Health and Medicine.
Every vaccine and drug carries risks, she said, but “the committee’s scientific challenge is to determine whether the benefits outweigh the risk.”
Public health experts who study hepatitis B said they were pleased that the committee postponed the vote on that vaccine.
“Tabling the vote is appropriate and a relief,” said Dr. Noele P. Nelson, a senior author on the current guidelines for the vaccine and a former leader of the C.D.C.’s hepatitis vaccines work group.
“This discussion should not be rushed and would benefit from a more comprehensive evaluation of the public health impact,” she said.
Babies are routinely immunized for hepatitis B within 24 hours after birth. The committee was scheduled to vote on whether the vaccine should instead be recommended only to those newborns whose mothers are known to be infected. The proposed vote suggested that other babies should be immunized only after they are at least one month old.
Hepatitis B experts noted that the vaccine has nearly eliminated 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.
“A universal birth dose recommendation is the only way to ensure we don’t miss vaccinating newborns exposed to this virus, including those whose mothers were not tested during pregnancy,” said Dr. John W. Ward, director of the Coalition for Global Hepatitis Elimination and a former head of the C.D.C.’s viral hepatitis division.
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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