At the first meeting of a controversial new group of vaccine advisers to the US Centers for Disease Control and Prevention, the committee announced new plans to study established vaccine guidelines.
The Advisory Committee on Immunization Practices will create new work groups to study the cumulative effects of the childhood and adolescent vaccine schedules, the hepatitis B vaccine dose given at birth and the combination measles, mumps, rubella and chickenpox vaccine, new chair Dr. Martin Kulldorff announced at Wednesday’s meeting in Atlanta.
It was the first time the new group of seven outside CDC vaccine advisers has convened since US Health and Human Services Secretary Robert F. Kennedy Jr. dismissed the previous panel of 17 experts this month, claiming that they had conflicts of interest. He appointed a new group of eight members two days later; one withdrew during the financial holdings review, leaving seven to review the nation’s vaccine recommendations.
Public health experts were concerned about both the unprecedented dismissal of the previous committee and the background and positions of some of the new advisers; two have served as expert witnesses against vaccines in trials, and another has suggested, against evidence, that Covid-19 vaccines contributed to the deaths of young people and should be removed from the market.
Kennedy, who helmed the anti-vaccine group Children’s Health Defense before becoming HHS secretary, has suggested that childhood vaccines have been inadequately studied, something pediatricians and infectious disease experts say is not the case.
The American Academy of Pediatrics said Wednesday that it would no longer participate in ACIP meetings because, “with the committee dismissals, it is no longer a credible process.”
“We won’t lend our name or our expertise to a system that is being politicized at the expense of children’s health,” President Dr. Sue Kressly said, pledging that the organization will continue to publish its own recommended immunization schedule “developed by experts, guided by science, trusted by pediatricians and families across the country.”
Kulldorff said the new work group on the childhood and adolescent vaccine schedules will review “interaction effects between different vaccines, cumulative amounts of vaccine ingredients and the relative timing of different vaccines.”
Each time a vaccine is added to the schedule, its interaction with other vaccines is reviewed, said Dr. Paul Offit, a vaccine scientist at the Children’s Hospital of Philadelphia and a member of an outside vaccine advisory panel to the US Food and Drug Administration.
“You have to prove that your vaccine doesn’t interfere with the safety or immunogenicity profile of existing vaccines and vice versa,” he told CNN on Wednesday.
Offit said the plans from the new committee are “just a purely anti-vaccine agenda springing to life in public policy.”
A second new work group will look at vaccines that haven’t been reviewed in more than seven years, Kulldorff said, including whether the hepatitis B vaccine should be universally recommended for newborns.
“Unless the mother is hepatitis B-positive, an argument could be made to delay the vaccine for this infection, which is primarily spread by sexual activity and intravenous drug use,” Kulldorff said.
The CDC says that “universal HepB vaccination of all infants beginning at birth provides a critical safeguard and prevents infection among infants born to [hepatitis B]-positive mothers not identified prenatally.”
“Scientific evidence overwhelmingly supports the safety of hepatitis B vaccines,” the agency says.
The American Academy of Pediatrics said on social media on Wednesday that “Hepatitis B can be passed from parent to baby at birth – and when that happens, the consequences can be deadly. It is unscientific and dangerous to ignore the success of US vaccination programs or argue that the US should not vaccinate babies for hepatitis B at birth.”
When the universal birth dose recommendation was temporarily suspended in 1999, some confusion ensued, and about 10% of hospitals suspended all birth doses regardless of infants’ degree of risk, Offit wrote in the New England Journal of Medicine in 2007. “One 3-month-old child born to a Michigan mother infected with hepatitis B virus died of overwhelming infection,” he said.
A third new work group will look at vaccines for measles, mumps, rubella and chickenpox, or varicella, Kulldorff said, noting that “vaccines are important for combating measles for the first dose at age 12 to 15 months.”
The vaccine is available as a combination of all four, or as two shots with the one protecting against varicella given separately. There is a well-understood higher risk of febrile seizures when the four-vaccine combination is given to children between ages 1 and 2; giving the varicella vaccine separately from the MMR vaccine avoids this increased risk, which the CDC points out is “very low for both options.”
Kulldorff said that the committee may reevaluate the combination vaccine recommendation for 1-year-olds and that the working group may look at the optimal timing of the vaccine and potential alternatives, such as one used in Japan.
Measles vaccination rates have been declining in the US, and more than 1,200 cases have been reported this year, among the most since the disease was declared eliminated in the US in the year 2000. Two school-age children have died in an outbreak centered in West Texas, and one adult died in New Mexico. All were unvaccinated.
The ACIP’s recommendations historically have held significant sway; they influence both insurance coverage and state policies around vaccination.
