The Advisory Committee on Immunization Practices (ACIP) under the Centers for Disease Control and Prevention (CDC) convened in September for the first time since June. Their assembly resulted in a series of crucial decisions aimed at revamping the federal immunization guidelines. These changes remain subject to approval by the acting CDC Director, Jim O’Neill.
The ACIP’s decisions unfolded over two days. On September 18, an 8 to 3 vote with one abstention emerged against the recommendation of the quadrivalent MMRV (Measles, Mumps, Rubella, and Varicella) vaccine to children under four. This decision was informed by evidence suggesting that administering the MMRV vaccine in children aged 12 to 23 months could lead to a marginally higher risk of fever-induced seizures. Notably, about 85% of U.S. children are currently provided with separate vaccines, though a combined vaccine is available. The ACIP, after reviewing the same evidence in the past, chose flexibility in its guidelines permitting parental decisions.
On its second day (September 19), the ACIP, by a 9-to-0 vote, decided to alter the Vaccines for Children resolution concerning MMRV vaccination. This meant that the program will not pay for the combined shots. This session also included votes on Hepatitis B and COVID-19 vaccines. A unanimous vote that all pregnant women get tested for Hepatitis B infection was achieved. but the first dose delay of the Hepatitis B vaccine for infants born to mothers testing negative held off due to ambiguity over the recommendation’s phrasing.
In a unanimously agreed-upon decision, the ACIP also recommended a comprehensive informed consent process concerning COVID-19 vaccines. The Committee suggests that individuals aged six months and above participate in shared decision-making with their healthcare providers about vaccination. This aspirationally encourages professionals to thoroughly discuss vaccine risks and benefits, contrasting prior suggestions for universal vaccination of individuals within the same age bracket. A draw in votes concerning prescriptions for COVID-19 vaccines led the ACIP Chair Martin Kulldorff, Ph.D., to break the tie by voting against the necessity of prescriptions.
The backdrop to this meeting is a flux in state actions as many have been effectuating steps to widen vaccine accessibility, unfettered by federal policy considerations. For instance, the West Coast Health Alliance rolled out a common plan for the 2025-26 virus season on September 17. Ensuingly, the East Coast states initiated a similar collaborative initiative, the Northeast Public Health Collaborative, which issued COVID-19 vaccine recommendations that diverge considerably from federal guidelines.
Lastly, the ACIP committee composition itself was dramatically altered by HHS Secretary Robert F. Kennedy Jr. in June as all of its 17 members were replaced with 13 new ones. The effects of these sweeping changes and how they play out in Medicaid — the largest children’s insurance provider in the U.S. — remain to be seen.