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The front line in the escalating political, cultural and scientific war over vaccination in the United States will return to a meeting room at the Centers for Disease Control and Prevention in Atlanta on Thursday and Friday.
That’s where an important CDC vaccine advisory committee – whose members were replaced with appointees of Health and Human Services Secretary Robert F. Kennedy Jr. – is scheduled to take another series of votes that could reshape longstanding recommendations to protect babies against the cancer-causing hepatitis B virus.
The two-day meeting of the CDC Advisory Committee on Immunization Practices is happening in the wake of Kennedy personally ordering changes to language on the CDC’s website that diminishes the agency’s longstanding statement that “vaccines do not cause autism” as not being an evidence-based claim – despite decades of research that has not found a link between vaccines and autism.
And it comes less than a week after a top U.S. Food and Drug Administration vaccine official asserted in a memo to agency staff – without providing data – that at least 10 children’s deaths are related to Covid-19 vaccination. The FDA has not released any information about the cases or how any links were made to vaccines.
With the advisory committee scheduled to start meeting at 8 a.m. Eastern Thursday, the CDC had not posted a final meeting agenda by Wednesday evening. The posted draft agenda – listed only broad topics of discussion, without details about the specific issues of concern, the data that will be presented, or the names of individuals who will be making presentations. Sometime overnight, a final agenda was posted that added a few lines of additional information but still few details.
Here’s what public health practitioners say they are watching for at this week’s ACIP meeting, which will be livestreamed on Thursday and Friday.
Votes that may delay or limit babies’ protection against hepatitis B
At issue: The meeting’s agenda shows that Thursday’s session will be focused on discussions and votes related to this vaccine. Overnight the committee posted draft language for two proposed recommendations.
The first vote is on language that would change current recommendations for universal vaccination of babies soon after birth. The proposed new ACIP recommendation would be for “individual-based decision-making, in consultation with a health care provider” on whether to give the hepatitis B vaccine to infants born to women who test negative for the virus or whose status is unknown.
This proposed recommendation also would leave it up to parents, in consultation with their health providers, to “decide when or if their child will begin the HBV series.”
The second vote involves draft language that would recommend that parents consult with health care providers about giving their children blood tests to check levels of immunity before receiving follow-up hepatitis B shots. The cost of these tests should be covered by insurance, the draft language says.
At the committee’s last meeting in September, the group postponed a vote on recommending a delay for when babies receive a first dose of hepatitis B vaccine.
Currently all babies are recommended to be vaccinated against this virus soon after birth. This is done to help prevent infection during the birth process if the mom’s infection hasn’t been detected during prenatal screenings, and also to protect them from exposure to caregivers and other contacts who may not know they are infected.
ACIP members have previously discussed the need for better hepatitis B screening of mothers during pregnancy. Other concerns have been raised about whether only babies deemed to be at high risk of virus infection should receive the shots.
Why it matters: Universal infant and childhood vaccination against hepatitis B has reduced by 99% the number of reported cases among U.S. children, adolescents, and young adults. The vaccine plays a significant role in preventing liver cancer caused by the virus.
“We have tried all of these methods that we’re now talking about potentially going back to and they did not work. So that is why universal vaccination is so important,” Michaela Jackson, the Hepatitis B Foundation’s program director for prevention policy, told Healthbeat before the final agenda was released.
“Prior to universal vaccination, only 50% of children who were being infected before the age of 10 were getting that from mother-to-child transmission,” she said. “The other 50% were getting it from places like day cares, from contact sports, from caregivers who didn’t know that they had hepatitis B. We’re talking about innocent interactions that you don’t really think about every day.”
The virus is highly infectious. It is transmitted through contact with blood and bodily fluids of infected people, who often have no symptoms or awareness they are living with the virus. While the virus can be spread through childbirth, sexual contact, and sharing contaminated needles, it also can be spread through contact with sharp items commonly shared in families: nail clippers, a toothbrush, even some kinds of jewelry.
Interest in changing the childhood and adolescent immunization schedule
At issue: It’s unclear what aspects of the schedule will be discussed. The posted draft agenda, which listed this as a discussion topic for Friday, didn’t say. The final agenda shows the presentation to the committee on this topic will be made by Aaron Siri, a lawyer and close adviser to Kennedy.
Critics of the current recommendations for when vaccines are given, including Kennedy, have questioned the number, timing, and spacing of shots.
The final agenda lists two sub-topics for Siri’s presentation: the evolution of the vaccination schedule and a comparison of the U.S. schedule to those in other countries.
Why it matters: “The childhood immunization schedule is an important framework that we use to protect children from harmful and potentially deadly childhood diseases,” Dr. Sean O’Leary, chair of the American Academy of Pediatrics committee on infectious diseases, said before the final agenda was posted.
“Every vaccine on that schedule and the recommended timing of it exists for a reason,” he said. “The timing of each dose of a vaccine for a child is critical, and it’s based on the age at which a child’s immune system can provide optimal protection after vaccination, and the earliest possible time for protection … There is no reason to delay or space out vaccines. Doing so just puts children at risk.”
Discussion of ‘adjuvants and contaminants’ in vaccines
At issue: The meeting’s draft agenda said there will be a discussion of adjuvants and contaminants on Friday afternoon. The final agenda describes the presentation as involving aluminum exposure from vaccines before the age of 24 months and persistent asthma at age 24 to 59 months.
Why it matters: “Just like the childhood vaccine schedule itself, every vaccine ingredient plays an important role in making sure the vaccine is safe and effective,” O’Leary said.
“I won’t be surprised if some on this committee refer to these ingredients as contaminants. This is simply false,” he said. “As with any medicine, the ingredients in vaccines are there for a reason. Aluminum, for example, they’ll talk a lot about aluminum. It’s one of the ingredients that vaccine skeptics like to go after.”
Aluminum salts, which are used in some vaccines – including diphtheria, tetanus and acellular pertussis, hepatitis A, and hepatitis B vaccines – boost the body’s immune response to the vaccine, O’Leary said.
“They’ve been safely used in vaccines for about 100 years and have been received by billions of people,” said Dr. Jesse Goodman, professor of medicine and infectious diseases at Georgetown University. “They strengthen our immune response and keep the antigens of the vaccine from disappearing too quickly.”
Wildcard issues, including alleged children’s deaths from Covid-19 shots
At issue: It’s been difficult for the public and public health stakeholders to provide focused input to the committee because information has not been shared in advance about the substance of the issues that will be discussed.
Why it matters: “There’s like zero transparency in this draft agenda,” said Rekha Lakshmanan, executive director of The Immunization Partnership, a Houston-based advocacy group. “We don’t know who’s going to be speaking. You know, it’s sort of like this rough outline that you put together in high school.”
With the ACIP meeting coming soon after last week’s internal FDA memo alleging 10 children’s deaths have been linked to Covid-19 vaccination, Lakshmanan, O’Leary and others said it’s possible the committee will raise the issue.
Alison Young is Healthbeat’s senior national reporter. You can reach her at ayoung@healthbeat.org or through the messaging app Signal at alisonyoungreports.48
