Robert F. Kennedy Jr. has long criticized an obscure and powerful federal vaccine committee. If senators confirm him to lead the Department of Health and Human Services, he would control it.
Kenndy is scheduled to meet with senators this week for confirmation hearings, where his vaccine views are expected to come under scrutiny.
The Advisory Committee on Immunization Practices — an influential group of clinicians and scientists — recommends who should get vaccines to the Centers for Disease Control and Prevention, the nation’s public health agency.
ACIP widely shapes public health practices, pharmaceutical development and how doctors treat patients. ACIP makes recommendations to the CDC, which almost always endorses the committee’s decisions.
“It is the most important policy making body with respect to vaccines in the United States,” said attorney Richard Hughes IV, who teaches at George Washington University and advises vaccine manufacturers.
Experts in public health said they fear Kennedy, if confirmed by the U.S. Senate, would appoint advisors who share his vaccine skepticism and who could weaken the committee’s recommendations, jeopardizing public health.
The HHS Secretary is authorized to remove or add members at will. That power, lawyers and public health officials say, amounts to one of the most significant levers the secretary has over immunization policy in the U.S.
That’s because the committee’s reach extends into American lives in ways that are often imperceptible.
The committee approves free vaccines for half the nation’s children. States look to ACIP recommendations to guide their school vaccination requirements. Federal laws require health insurers to pick up the entire bill for ACIP-recommended vaccines for most Americans with private health insurance, Medicare’s Part D prescription drug benefit and adults in Medicaid.
Control of the committee matters to the nation’s health, said Dorit Reiss, a law professor at the University of California, San Francisco, who studies vaccine policy.
“What we could see is more outbreaks of preventable disease as vaccine rates decline,” she said.
Press officers for Kennedy and President Trump didn’t respond to requests for comment.
Kennedy has previously criticized the advisory committee, whose members are independent scientists and physicians, as beholden to pharmaceutical companies. ACIP members must disclose potential financial conflicts each year and cannot discuss or vote on vaccines where they have personal financial interests.
ACIP’s job
It is common in the U.S. for scientists to advise agencies across the government on technical and practical policy questions. In the CDC alone, at least 20 groups advise policymakers on research into everything from lead exposure to breast cancer prevention.
Vaccine experts outside the government have consulted with policymakers for decades. ACIP emerged in the 1960s.
The committee’s principal job is to evaluate who should get vaccinated. That’s trickier to do than it may seem. First, members must answer several key questions: Who is at risk from an infection? Do the vaccine’s benefits outweigh its risks?
Members scour research and data to find answers. Most of their time is spent in smaller work groups, which also draw in specialists from the CDC, universities and medical societies. The work is intensive and can span months.
Drexel University Professor Sarah Long remembers one ACIP group that forced her to squeeze in an extra 40 hours of meetings over more than six months while holding down her day job teaching and treating patients. She was one of at least 94 people to pitch in.
Once finished, the full committee deliberates findings and votes at public hearings. Decisions are published, and the members list the evidence they considered as they weighed a vaccine’s benefits and harms, among other factors.
Experts brace for vaccine rollbacks
Public health officials and drug developers said they are bracing for the possibility the Trump administration could roll back vaccine recommendations.
Kennedy has said in recent interviews that he doesn’t want to take away vaccines, but has said people should have a choice and would make information available to make that decision.
Kennedy could deliver on the promise by naming ACIP committee members who favor more relaxed guidance.
ACIP recommendations fall into two broad categories: vaccines you should get and vaccines you might want to get, based on your risk.
Few vaccines carry the softer recommendation, known as shared clinical decision-making. Research shows it is more time consuming and confusing for physicians to follow.
Vaccine use may also drop with more relaxed guidance. In 2014, for example, the committee said older adults should get a pneumococcal vaccine manufactured by Pfizer. They voted in 2019 to soften that guidance, telling seniors to instead consider the option by talking with their doctors. Use of the vaccine fell, Pfizer told its inventors in financial statements. Pfizer declined to comment.
When the committee issues softer recommendations, it’s based on an analysis of evidence. Reiss from UCSF said she is concerned Kennedy could instead appoint members who prefer softer guidance on principle.
If that happened, Reiss said it would strike a blow to confidence in the committee for many. “The basis of its influence is trust,” she said.
ACIP decisions can influence investment in vaccine development
Doctors and public health officials aren’t the only ones closely tracking whether the new administration will weaken vaccine policy. Drugmakers have a lot riding on these recommendations.
The vaccine market is already limited. People usually need vaccines just once – or once a year – unlike drugs for chronic diseases that people take daily. Weaker recommendations from ACIP could mean fewer people taking vaccines, which makes investors nervous.
If that funding dries up, we could see fewer new vaccines hit the market or it could take them longer to get there.
For example, Danish drug company MinervaX recently completed the second stage two clinical trials to treat group B streptococcus, a life-threatening infection in newborns. It causes an estimated 90,000 infant deaths worldwide each year.
Currently, doctors prescribe mothers antibiotics before birth to protect newborns from infections, but a vaccine has been a top global public health priority for years.
MinervaX is backed by several investors, who are necessary to finance the multimillion dollar cost of clinical trials, Aziz said.
MinervaX’s CEO Per Fischer said his company will need even more capital to continue. He fears raising money will get harder if Kennedy is confirmed. “I think people are sort of applying this wait and see kind of approach and then hoping it's not going to be as bad.”
Funding for kids vaccines potentially at risk
The committee’s most direct power over immunization may be its control over billions of federal dollars to buy vaccines.
ACIP decides which vaccines to buy under the Vaccines for Children program, and the federal funding is guaranteed. Congress created the program after deadly measles outbreaks more than 30 years ago.
The epidemic, which ended in 1991, sent thousands of children to hospitals and killed 123 people. Some children who became ill had seen doctors, but were unvaccinated because their families couldn’t afford shots. Doctors had referred parents to free clinics for shots. The extra step became a barrier.
As a fix, Congress set up the Vaccines for Children to pay for immunizations that doctors give vulnerable children. It worked. Referrals to free clinics dropped. Measles vaccination rates increased.
About half the nation’s children are eligible for vaccines under the program, which, in 2023, spent $5.2 billion.
Some state public health officials are concerned appointments under Kennedy will shrink the program.
In Hawaii, 56% of children receive free vaccines. Doctors order about $19 million of children’s vaccines under the program, according to the state.
Ron Balajadia, who oversees the program for Hawaii’s Health Department, said the agency is in early meetings with lawmakers on new state funding to fill in gaps should ACIP begin to cut back the program under Kennedy.
He fears what may happen to the state’s children if Hawaii loses ground on immunization rates should money for vaccines disappear.
Balajadia has seen the toll of outbreaks firsthand. Early in his career, he responded to an outbreak of whooping cough, on islands in the Pacific.
He anchored one day on a small island in the Pacific Ocean. He was met by a distressed mother and local health care worker holding a baby in spasms. The infant was vomiting and blue.
Balajadia could do nothing. “It haunted me, in the way that I wanted to help, but I couldn't.”
Balajadia worries that handing Kennedy control over funding for children's vaccines would threaten to undermine a hard-won public health lesson: Research shows policies that make vaccines low-cost or free help push up public protection against diseases to levels that, largely, prevent outbreaks.
“That's the part that I fear the most,” he said, “is if we have another outbreak.”
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