Vaccine Access Updates: What Physicians Need to Know

A federal vaccine panel will meet this week for the second time since it was remade by Health and Human Services Secretary Robert F. Kennedy Jr.. Typically a routine affair to update vaccine schedules and issue new recommendations, the committee’s meeting this Thursday and Friday could be particularly consequential for U.S. immunization policy.

Known as the Advisory Committee on Immunization Practices, the panel will meet amid a leadership crisis at the Centers for Disease Control and Prevention and rising alarm among physicians that Kennedy will sharply curtail vaccine access.

Already, Kennedy has overhauled ACIP, firing the 17 prior members of the panel and appointing seven hand-selected advisers in their place. At their first meeting, in June, the new panelists questioned use of COVID-19 vaccines and voted to remove a controversial, but little-used, vaccine preservative from flu shots.

Kennedy’s actions have sparked backlash. The ousted ACIP members have called for creation of an alternative to their former committee, warning of damage to U.S. vaccine policy. Medical groups are pushing back against the CDC and setting their own childhood vaccine recommendations, as several states move forward with plans to decouple their vaccine guidance from the federal schedule. A number of Democratic lawmakers have now called for Kennedy’s resignation, as have hundreds of HHS staff.

Ahead of the meeting on Sept. 18 and 19, here’s what to know:

What's on the agenda?

A draft agenda released Friday shows this week’s ACIP meeting will focus on vaccines for hepatitis B, COVID, and measles, mumps, rubella and varicella.

Details for each discussion indicate that committee members will hear about seizures following vaccination with the “MMRV” shot, and about use of the hepatitis B vaccine at birth. The panel will vote on recommendations for both immunizations.

All of Friday is set aside for discussion of COVID shots, which have become a flash point in Kennedy’s efforts to upend current vaccine policy. According to The Washington Post,the Trump Administration plans to link the deaths of 25 children to COVID vaccination, potentially as evidence supporting restrictions in access.

In recent statements, COVID vaccine manufacturers Moderna and Pfizer affirmed the safety of their shots. Moderna noted that it’s not aware of any deaths in the last year or new information from past years, while Pfizer detailed the comparative risk of heart inflammation called myocarditis related to its vaccine versus from other causes, like COVID disease itself.

ACIP agendas provide a framework for committee discussion. They reflect months of preparatory work by dozens of CDC staff and scientists, who sift through emerging epidemiological and clinical data to outline vaccine benefits, risks and use.

In the usual course of business, CDC staff, company representatives or other experts provide presentations on vaccines set for discussion.

So, who’s on ACIP now?

In June, Kennedy replaced the 17 previously vetted and confirmed ACIP members with eight new advisers he chose, citing unsubstantiated conflicts of interest. One of the eight later decided against participating. Among the seven now serving are vaccine skeptics and physicians whose specialties are in fields other than immunology and epidemiology.

One, MIT business professor and mRNA vaccine critic Retsef Levi, was recently named to lead a revamped COVID working group and will lead several discussions Friday, per the draft agenda.

Ahead of this week’s meeting, Kennedy has been pushing to add more panelists to the smaller-than-usual roster. Nearly two weeks ago, physician Jeremy Faust reported in his Substack publication Inside Medicine on seven candidates that had been floated as potential nominees

HHS confirmed the appointment of five of those candidates on Monday. It’s not clear how they were vetted, and among them are individuals whose backgrounds are atypical for ACIP

One is Kirk Milhoan, a pediatric cardiologist and pastor who founded a Christian medical mission organization in 2001. He’s recently served as a senior fellow at the nonprofit Independent Medical Alliance.

State officials and legislators in Hawaii previously called for an investigation of Milhoan for spreading misinformation about using hydroxychloroquine and ivermectin to treat COVID. He has advocated against use of the COVID vaccines in children, citing cardiac safety concerns related to the shot that data show are very rare.

Milhoan’s biography on the Independent Medical Alliance’s website says he is “dedicated to treating patients affected by acute SARS-CoV-2 infections, Long Covid, and vaccine-related cardiovascular toxicity due to the spike protein.” Many vaccine skeptics and activists have focused on the coronavirus spike protein, which vaccines train the body’s immune system to recognize, but they argue is inherently toxic.