Federal vaccine advisers will convene this week to review major elements of the childhood immunization schedule and to reconsider long-standing vaccination practices, including the timing of the newborn hepatitis B shot and the composition or delivery of more than a dozen other vaccines such as those for measles, mumps, pertussis and polio.
The Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices (ACIP) meets Thursday and Friday to reexamine the timetable pediatricians use to administer more than 30 recommended doses. The session follows broad personnel changes at ACIP made in June by Health and Human Services Secretary Robert F. Kennedy Jr., who has questioned vaccine safety and effectiveness for many years.
Supporters of the administration’s shake-up say the changes bring overdue scrutiny. Mary Holland of Children’s Health Defense, a vaccine-critical nonprofit co-founded by Kennedy, praised the moves as exposing “truth telling about vaccines” and criticized mainstream medical institutions. But many public health specialists worry the review will undermine immunization coverage and fuel outbreaks of preventable illness.
“We now seem to have entered a dangerous new phase in Secretary Kennedy’s campaign to shut down scientific expertise, silence the best available evidence, and replace it with his own personal agenda,” said Dr. Sean O’Leary, a pediatric infectious disease professor who chairs the American Academy of Pediatrics’ committee on infectious diseases.
ACIP, established in 1964, has been seen as a leading authority on pediatric vaccination. Its recommendations influence clinical practice and insurance coverage decisions. Critics say the committee’s credibility with mainstream medical organizations has weakened since Kennedy installed a new slate of members. The revised panel has curtailed collaborations with groups such as the American Academy of Pediatrics and has relied less on CDC scientists.
The committee’s September meeting descended into confusion when a planned vote on hepatitis B vaccination was postponed. ACIP recently replaced its chair; the current chair, Dr. Kirk Milhoan, is a pediatric cardiologist and a fellow with the Independent Medical Alliance, an organization that has promoted unproven COVID-19 therapies such as ivermectin.
Confidence in the CDC was further shaken when the agency last month adjusted its language about whether vaccines might be linked to autism — a claim long rejected by extensive research but championed by Kennedy and some critics. In response, independent medical organizations including the American Academy of Pediatrics and the American Academy of Family Physicians, as well as a Vaccine Integrity Project at the University of Minnesota, have issued separate guidance that some states are following.
A new ACIP working group has been charged with examining the childhood immunization schedule. Public health officials say the timing of that review is concerning as immunization rates have fallen and outbreaks of vaccine-preventable diseases have risen.
“We have seen more measles cases in our country this year than we have in recent history. In my own community, we’re seeing quite significant upticks in pertussis,” said Dr. Raynard Washington, director of Mecklenburg County Public Health in Charlotte, N.C. He warned that added bureaucracy or procedural barriers to vaccination could threaten community health.
Vaccine advocates emphasize that each recommended vaccine and its timing are based on evidence about when a child’s immune system responds best and when the child is most at risk. “Every vaccine on that schedule and the recommended timing of it exists for a reason,” O’Leary said, adding that delays or spreading out doses increase children’s risk of infection.
Some critics argue that multiple vaccine antigens or ingredients might overwhelm an infant’s immune system. Experts counter that children are exposed to far more immune stimulation from everyday microbes than from vaccines, and that modern vaccines are formulated to minimize unnecessary components. “These newer vaccines are a good thing. They save lives,” O’Leary said.
Hepatitis B newborn dose under scrutiny
One likely agenda item is a vote on the long-standing recommendation to give all newborns a hepatitis B vaccine within 24 hours of birth. Alternatives being considered include delaying the first dose or requiring a more detailed parental discussion prior to immunizing newborns.
Proponents of changing the universal birth dose argue that hepatitis B is most commonly transmitted through sexual contact or injection drug use, and that screening pregnant women and vaccinating only infants born to infected mothers might be sufficient. They note that some other countries do not routinely give the birth dose.
Public health experts caution that such an approach would be risky. Hepatitis B is highly infectious and can be spread through contact with infected blood and body fluids; household exposures to contaminated items can also transmit the virus. Most infants who acquire hepatitis B become chronically infected and face increased lifetime risks of liver disease and cancer.
A new analysis presented to ACIP suggests delaying the hepatitis B birth dose by several months could result in more than $222 million in additional health-care costs and hundreds of preventable deaths annually. “Universal vaccination has been the cornerstone of hepatitis B elimination efforts for decades,” said Eric Hall, an epidemiologist at Oregon Health & Science University and co-author of the analysis. He urged maintaining the current policy credited with dramatic declines in hepatitis B infections.
O’Leary emphasized the vaccine’s strong safety record and noted practical complications of postponing the birth dose: later doses are administered as part of combination vaccines, so rescheduling could complicate delivery and increase missed vaccinations. He also pointed out that pediatricians work with families and that parents participate in immunization decisions.
Other items under review
ACIP members are also examining proposals that could split combination vaccines such as the MMR (measles, mumps, rubella) into separate shots. Experts warn separating combined vaccines would require more clinic visits and injections and likely lead to lower completion rates.
The committee’s working group is evaluating the safety of aluminum adjuvants — small amounts of aluminum compounds used for decades to enhance immune responses in several vaccines, including some for diphtheria, tetanus, hepatitis and influenza. The review includes assessing whether particular aluminum adjuvants might increase asthma risk.
Most public health authorities say there is no credible evidence that aluminum adjuvants are unsafe. Large studies have not demonstrated harms, and people ingest far more aluminum from food and the environment than they receive from vaccines. Some critics nevertheless assert aluminum contributes to conditions such as autism or ADHD, claims that rigorous research has not supported.
“Based on large, long-term studies and immunology research, there is no evidence that vaccines cause either allergies or autoimmune disorders,” Dr. Frank Virant of the American Academy of Allergy, Asthma & Immunology told reporters. Removing aluminum from vaccines would likely undermine their effectiveness; substitutes are not readily available and reformulation could take years.
What’s at stake
Public health experts say the outcome of this meeting could have broad consequences. The childhood immunization schedule reflects decades of research and practice designed to protect children when they are most vulnerable. Changes that reduce vaccine uptake or complicate delivery risk reversing long-standing public health gains.
As ACIP deliberates, the debate highlights deeper battles over scientific authority, public trust in health institutions and how best to protect children’s health. Officials and clinicians warn that policy shifts that increase hesitancy or decrease coverage could lead to more illness, higher costs and preventable deaths.