For the past 50 years, a committee of independent experts has advised the federal government on vaccine policy, providing guidance on which shots people should get and when. Government public health officials have almost always followed the panel's recommendations, all but making it the final word on public health policy in the US for most of its existence.
But on Monday, Health Secretary Robert F. Kennedy Jr. fired every sitting member of the Centers for Disease Control and Prevention's (CDC) Advisory Committee on Immunization Practices (ACIP), a move that stunned doctors and scientists across the country. And it means that the CDC's days as the clear and unchallenged authority on US vaccine policy appear numbered.
Kennedy framed his decision to clear out the members as necessary to restore public trust in the government's vaccine recommendations. In a Wall Street Journal op-ed, Kennedy asserted the committee "has been plagued with persistent conflicts of interest and has become little more than a rubber stamp for any vaccine."
Kennedy has said mainstream scientists — the kind who staffed ACIP before this week — have been too deferential to pharma companies and too reluctant to consider vaccines' supposed harms, including the long-debunked claim that vaccines can cause autism, which Kennedy has pushed for years.
All that fits with Kennedy's broader critique of the medical establishment being beholden to big business interests at the expense of patients, a critique that many Americans share, and with his ongoing efforts as health secretary to overhaul US vaccine policy.
New committee members will be announced at some point, but as of Tuesday, even top US senators did not know who the replacements would be. The panel is supposed to hold one of its periodic public meetings in late June to discuss the Covid-19 vaccine, as well as shots for RSV and HPV, among others.
This is a watershed moment in US public health, one that seems sure to sow confusion among patients and health care providers. The deepening divide between Kennedy's Make American Healthy Again (MAHA) movement and mainstream medicine could make it harder for people who want vaccines to get them, while encouraging more doubt about the value and safety of shots among the general public.
Kennedy's decision raises all sorts of questions: Will doctors follow the CDC guidance, even if it changes under a new advisory panel staffed by Kennedy loyalists, or will they stick with the earlier vaccine schedule? Will health insurance plans cover the cost of a vaccine that professional medical organizations support but the CDC does not?
Some doctors already believed, before the firings at ACIP, that the CDC was no longer trustworthy under Kennedy's leadership; his unilateral change to the Covid vaccine guidance in May was enough to convince them. In a media call last week, experts from the Infectious Disease Society of America urged patients and providers in the short term to consult with professional medical societies — not the CDC — on vaccine recommendations. They considered those groups, as well as guidance from European health authorities, the best substitutes we currently have for information on vaccines if the CDC's recommendations can no longer be taken at face value.
While those societies plan to do their best to issue helpful guidance, they are not the government. The fact that the nation's top health official is now telling Americans that they should never have trusted the ACIP, risks pushing more people to skip routine immunization — and that could have dangerous results.
If changing opinion leads to declining vaccination rates, diseases that we successfully stamped out through vaccines could rebound — which is exactly what we are seeing now with measles.
The US is experiencing its highest number of measles cases since the 1990s, nearing 1,200 as of this writing. One outbreak that accounts for most of those cases took off in a small Texas community where vaccination rates had fallen far below the 95-percent threshold that is considered necessary to stop the virus's spread.
Other knock on effects could hurt Americans who still want to get vaccinated. Pharma companies, the target of so much of Kennedy's criticism, could decide to stop pursuing new vaccines if they believe the federal government will limit access as much as possible, shrinking the world's biggest pharmaceutical market. Vaccines are not big moneymakers for drug companies, and they have often relied on the US government's support to develop new ones.
Kennedy, however, has canceled major vaccine development contracts during his first few months as health secretary, including a $700 million contract with Moderna, one of two companies that produced the mRNA Covid vaccines, to work on a universal flu shot.
Kennedy has quickly disrupted decades of public health consensus. For now, the best reaction is, oddly enough, for patients and providers to take him at his word when he says people should not take medical advice from him — and make their own decisions in collaboration with their doctors.
