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During his January confirmation hearing before the Senate Finance Committee, Robert F. Kennedy Jr. vowed to usher in an era of “radical transparency” if confirmed to head the Department of Health and Human Services (HHS). But this week, just shy of four months into his tenure, the HHS chief is making big changes to a longstanding vaccine advisory committee—and few public health experts know what to expect next.
On Monday, Kennedy fired all 17 members of the Advisory Committee on Immunization Practices (ACIP), a panel that makes recommendations upon which the federal government typically bases its vaccine guidance. Then, on Wednesday, he named eight new members to the committee, among them prominent vaccine critics and purveyors of misinformation. “All of these individuals are committed to evidence-based medicine, gold-standard science, and common sense,” Kennedy said of the decision, which he claimed was aimed at rooting out conflicts of interest.
“The U.S. Department of Health and Human Services is putting the restoration of public trust above any pro- or antivaccine agenda,” Kennedy wrote in a Wall Street Journal op-ed published Monday. “The public must know that unbiased science guides the recommendations from our health agencies. This will ensure the American people receive the safest vaccines possible.”
But a number of scientists and public health officials have described the move to clean house as both unprecedented and alarming, warning that undermining the committee could threaten vaccine coverage and erode public trust. Established in 1964, the ACIP advises the Centers for Disease Control and Prevention (CDC) on how vaccines should be used. The committee is made up of up to 18 leading experts representing different fields of public health—pediatricians, pharmacists, immunologists, and physicians, for example—and one layperson who presents the attitudes and insights of the general public.
The full committee gathers three times a year, but smaller working groups convene between meetings to deliberate on data, discuss possible recommendations, and prepare presentations. The ACIP also enlists the help of liaison representatives from professional and scholarly organizations such as the American Academy of Pediatrics and the American Academy of Family Physicians, who participate in—but don’t vote on—vaccine recommendations.
As your TMD editors learned all too well during the COVID-19 pandemic, vaccines are typically recommended by the federal government in a two-stage process. During the development phase, vaccine manufacturers conduct clinical trials under the supervision of the Food and Drug Administration (FDA), providing information on an immunization’s safety and efficacy. From there, the FDA makes the vaccines available through licensure or, in the case of the COVID-19 shots, emergency use authorization. It’s then largely in the hands of the ACIP to offer recommendations on who should receive the immunization, when, and how often, although the CDC director has final sign-off.
Members of the ACIP typically serve four-year terms, which are staggered to allow for time between new appointments. HHS secretaries have the power to remove advisers at will, but Kennedy’s decision to clean house seems to bypass the thorough, nonpartisan vetting process typically used to select new members. “Without removing the current members, the current Trump administration would not have been able to appoint a majority of new members until 2028,” Kennedy wrote in his op-ed.
Dr. William Schaffner, a professor of infectious diseases at the Vanderbilt University Medical Center who has been associated with the committee since 1982—first as a full member, and now as a liaison representative—described the move as unprecedented. “The entire membership of the committee has never been relieved and the entire committee reconstituted in its now-61 years of history. It’s always been important to have institutional memory that’s carried over as new members are brought in and become acquainted with the issues that are under current deliberation,” he told TMD. “So there is no doubt that the removal of all the members in one fell swoop, as has just happened, has caused not only a great surprise to the public health, vaccine, and clinical communities, but it’s created a great deal of anxiety and raised a lot of questions.”
Kennedy has argued that the committee had long suffered from conflicts of interest and a lack of transparency. But current and former members have refuted that characterization, pointing out that prospective members must publicly disclose any potential conflicts and, if appointed, abstain from voting on recommendations for vaccines whose manufacturers they are affiliated with. Additionally, full committee meetings are livestreamed and recorded.
“This process is wonderfully transparent. Anyone in the United States who’s interested in this phenomenon can watch it on the internet in real time,” Schaffner said. “The committee members, before they are appointed, are vetted very carefully for conflicts of interest. This has become much more formal and much more rigorous over the 30-plus years that I’ve been associated with the committee.”
Dr. Paul Offit, the director of the Vaccine Education Center at Children’s Hospital of Philadelphia who served as an ACIP member between 1998 and 2003, described Kennedy’s criticisms as a false pretext to oust advisors with whom he disagrees. “These committee members generally support the science behind vaccines, and he doesn’t,” Offit told TMD. “He’s an anti-vaccine activist and a science denialist, so I think he’ll be likely to try and put people on the committee who are like-minded.”
That may already be happening. One of Kennedy’s new appointees, Dr. Robert Malone, generated controversy after a 2021 appearance on “The Joe Rogan Experience” during which he made a number of false claims about COVID-19 vaccines. He has also promoted the use of hydroxychloroquine and ivermectin to treat coronavirus. Another new adviser, Retsef Levi, said there was “mounting and indisputable” evidence that mRNA vaccines “cause serious harm including death, especially among young people” in a still-pinned post on X.
Together with Kennedy’s recent decision to reverse CDC recommendations that healthy children and pregnant women receive coronavirus shots, announced last month via X, doctors are now concerned that the changes may ultimately affect vaccine coverage. The Vaccines for Children (VFC) program uses ACIP guidance to provide free vaccines for uninsured and Medicaid-eligible children, and some health care providers and insurance agencies may be reluctant to administer or cover vaccines for patients for whom they aren’t explicitly recommended.
“[Kennedy] said, ‘I will never take vaccines away from anybody who wants them.’ He just did that. He also said that he’s going to usher in an era of radical transparency. This isn’t only not radical transparency—it’s not transparency at all,” Offit said. “He makes these decisions behind closed doors, he comes down and delivers it on X like he’s been handed stone tablets on Mount Sinai, and just tells us what we’re going to be doing without any input from not only advisory groups or professional societies, but from the public.”
The decision also risks politicizing and ultimately undermining a body once looked to as a template for vaccine review committees across the globe.
“All of us are watching these very substantial changes with interest and a certain degree of anxiety, because I certainly believe that the appropriate implementation of vaccines has been one of the largest public health triumphs over the last 50 years, in the United States and, by extension, around the world,” Schaffner added. “None of us with gray hair, who have seen these past communicable diseases in children and adults, want to ever see them again.”
GOP Sen. Bill Cassidy of Louisiana, who voted to confirm RFK Jr. to lead HHS despite concerns about his anti-vaccine views, in a post on X:
Of course, now the fear is that the ACIP will be filled up with people who know nothing about vaccines except suspicion. I’ve just spoken with Secretary Kennedy, and I’ll continue to talk with him to ensure this is not the case.
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Legendary Beach Boys bandleader Brian Wilson passed away at 82, his family announced on Wednesday. He influenced artists from Jim Morrison to Paul McCartney, leaving a musical legacy that cannot be overstated. “He wrote some music that when I played it, it made me cry and I don’t quite know why,” McCartney said when inducting Wilson into the Songwriters Hall of Fame. “I think it’s a sign of great genius to be able to do that with a bunch of words and a bunch of notes.” Here’s a 1964 Beach Boys performance on the Ed Sullivan Show, when Wilson was only 22 years old.
Do you have a favorite Beach Boys song or performance?