Vaccine panel is turning misinformation into policy

Lisa Jarvis, Tribune news Service

Health and Human Services Secretary Robert F. Kennedy’s dismantling of Americans’ trust in — and ultimately, access to — vaccines isn’t happening with one sweeping policy that grabs the public’s attention. It’s unfolding quickly and quietly, in bland conference rooms where hand-picked appointees make decisions that will have far-reaching consequences for our health.

Inside one of those nondescript rooms last week, the Advisory Committee on Immunization Practices (ACIP), an independent panel that makes vaccine recommendations to the Centers for Disease Control and Prevention, offered a glimpse of what’s to come. The group, few of whom have any expertise in vaccines, infectious diseases or epidemiology, at times cast aside evidence-based science and sowed doubt in some of our most valuable public health tools. This panel of seven replaced the 17 ACIP members Kennedy fired last month in order to stack the committee with members who share his anti-vaccine agenda.

Their lack of expertise and, for some, even basic knowledge of epidemiology, were evident throughout the two-day meeting. Some were unfamiliar with the Vaccines for Children Program, which provides free shots to those eligible. (The program has provided some 71.5 billion doses to kids since 1994.) At least one member appeared to struggle to understand the distinction between a vaccine’s efficacy and its effectiveness. It’s a wonky, but important distinction referring to how well a vaccine works in a trial versus the real world. Some seemed not to take seriously the risk that infections like RSV and the flu can pose to even healthy children. One member suggested that the 250 children who died from the flu last season — a recent high — was a “modest” number.

But this group isn’t just unqualified — it’s dangerous. Its decisions directly influence insurance coverage and access to vaccines, affecting health outcomes for all Americans. The stakes are particularly high when it comes to protecting children against preventable diseases. Yet the tone of the panel’s first formal meeting suggested many members are more intent on sowing doubt about routine immunisations. Even worse, their actions could impede access to these important medicines. “That whole meeting was a travesty,” says Fiona Havers, a physician and epidemiologist. After the ACIP firings, Havers resigned from the CDC, where she was considered one of its leading experts on vaccine policy.

Kennedy’s oft-repeated claim is that the COVID-19 response caused vaccine hesitancy in the US and that his drastic changes at the CDC are a necessary step in rebuilding the public’s trust. Martin Kulldorff, a former Harvard epidemiologist and chair of the panel, echoed that sentiment during the meeting’s opening, emphasizing the importance of “rebuilding trust in sound science,” and again at the end, when he commended participants for discussing vaccines in an “unbiased, open and transparent way.” It’s a convenient — and inaccurate — framing. It elides the role Kennedy’s Make America Healthy Again movement played in spreading vaccine misinformation during the pandemic. It provides cover for their “just asking questions” approach to evaluating vaccine policy.

The problem, of course, is when people given the CDC’s imprimatur are asking questions that are purposely crafted to sow doubt. That became clear from the outset when Kuldorff announced that the committee would evaluate the cumulative effects of the childhood vaccine schedule, as well as any immunizations that had not been considered in the last seven years, including the hepatitis B shot given to newborns. The implication is that the CDC has been ignoring some unknown dangers of shots that have been safely used for years. Kuldorff, who was fired from Harvard, was a vocal critic of COVID vaccine mandates during the pandemic and refused the shot. “The claims that were framed as efforts to increase vaccine confidence actually do the opposite — they undermine vaccine confidence,” says Sean O’Leary, the American Academy of Pediatrics’ liaison to ACIP. He called the meeting “a really long couple of days for science.”

A discussion of flu vaccines was a disturbing preview of what “rebuilding trust” might look like under Kennedy’s CDC — and how that mantra could be used to disrupt access to vaccines. After a thankfully routine vote to recommend that Americans get their fall flu shots, the panel stated that those vaccines should not contain thimerosal, a mercury-containing preservative that decades ago came under scrutiny for a now-disproven link to autism. It was a disturbing development that upended the panel’s normally measured process for evaluating vaccines. The discussion was added to ACIP’s agenda at the last minute, but more alarming was that thimerosal was being discussed at all. The preservative’s safety has been thoroughly studied, but was removed from all childhood vaccines in 2001 to try to address parents’ hesitancy. Today, it is used sparingly— the single-dose flu vaccines that the majority of Americans receive don't contain it, but it's still used as a preservative in multi-dose vials, which just 4-5% of patients in the US receive.

Most troubling was that the “evidence” against thimerosal was presented by Lyn Redwood, a nurse and former head of the Children’s Health Defense, the anti-vaccine group founded by Kennedy. She used her time to make a series of false claims about the preservative’s risks. Her original presentation cited a fake study on the risks of thimerosal — a reference removed after the media raised concerns. Pediatrician Cody Meissner, one of two rational members, questioned the purpose of her presentation and its contents. (Meissner was often the lone voice of reason and expertise on the panel during the two-day meeting.) Ultimately, when it came time to vote on recommending the preservative be removed from flu shots, Meissner was also the only member to vote against it. The vote has real consequences. It means some Americans will lose out on their shots. The vaccine is more commonly used outside the U.S., and there’s concern about how ACIP’s decisions could ripple into global health. And vaccine hesitancy experts worry that re-litigating a settled topic could undermine broader confidence in immunisations.

And perhaps most alarming is the precedent set by the committee bypassing the CDC’s normal review process to push through what seemed like a preordained decision. Typically, a CDC working group comprised of internal staff and subject matter experts would spend months developing recommendations that are presented to ACIP in a public forum. They would examine hard data on a vaccine within the broader context of its real-world use, considering, for example, the magnitude of the public health problem it addresses, challenges to implementing a rollout, and its impact on health equity, Havers explains. Before considering removing a shot like the thimerosal-containing flu vaccine, the working group would first study the public health consequences of the decision.

“None of that happened, which is why this was a complete farce,” Havers says. That’s the antithesis of transparency. And it’s a sign for what we can expect from this group. After watching the panel railroad a vote on settled science, it’s fair to worry about their future plans. The next effort to “rebuild trust” could have far-reaching health consequences — and, without a doubt, will cost lives.