By Grayson Logue
Thursday, December 11, 2025
The Advisory Committee on Immunization Practices is
tasked with helping the Centers for Disease Control and Prevention develop
vaccine recommendations based on the best data and medical science and informed
by leading vaccine and infectious disease researchers and doctors.
Or at least, that’s what the committee, known as ACIP, is
supposed to do.
The committee met last week for the third time since
Health and Human Services Secretary Robert F. Kennedy Jr. fired its previous
members and packed the panel with allies, skeptics, and openly anti-vaccine
advocates. Past ACIP convenings featured structured and dispassionate
discussions of the vaccine schedule. Their recommendations are always
consequential, but their meetings were typically jargony and boring.
This meeting was different. A chaotic two-day session
punctuated by shouting
matches, passive-aggressive insults,
and confusion about the agenda did not stop a majority of the panel from
removing a 35-year-old recommendation for a routine birth dose of the hepatitis
B vaccine. Anti-vaccine advocates gave presentations that public health
researchers and major medical associations criticized as distorted, inaccurate,
and misleading. The committee is now poised to deliver similar treatment to the
entire childhood vaccine schedule.
The meeting made explicit what was already becoming
apparent: The iconoclasts are in charge and pursuing a campaign against public
health guidance, as such.
The proceedings were at times confused and seemingly
rushed. Members had not seen the exact recommendation language beforehand and
had to delay voting to allow time for review. Three days before, a new chair
was installed, but he couldn’t run the meeting because he was traveling
internationally and missed much of the discussion. A member of the committee
work group that developed the new recommendations resigned
the night before because she had not seen any of the material.
Dr. Kevin Ault, vice president of the National Foundation
for Infectious Diseases, served on ACIP when it expanded the adult hepatitis B
recommendation to be universal in 2022. He told The Dispatch that
adjusting the recommendation took almost a year and that the language changes
were circulated to the full committee well in advance. Ault participated in
last week’s meeting as a liaison representative of the American College of
Obstetricians and Gynecologists. “Obviously this was put together at the last
minute,” he said of the votes.
A recommendation rollback.
The new guidance maintains the recommendation for infants
born to mothers who have tested positive for hepatitis B or whose status is
unknown, but mothers who test negative for hepatitis B should engage in
“individual-based decision-making, in consultation with a medical provider, for
… deciding when or if to give the HBV vaccine, including the birth dose.” The
recommendation also suggests that parents who choose to skip the birth dose
should wait until a baby is at least two months old for the first dose of the
vaccine. Notably, as vaccine skeptics on the panel emphasized,
the latter change does not affirmatively recommend that a dose be given at two
months, only that parents wait at least two months.
The change was not based on new findings or data
suggesting the vaccine may be less effective or pose safety risks, and in fact
the committee discussed a similar change at its September meeting, only to
delay a vote because of the very absence of such data. At the September
meeting, CDC scientists who specialize in hepatitis B presented a systematic
review of the evidence behind the routine recommendation. But this time,
several vaccine skeptics delivered the presentations on hepatitis B, including Cynthia
Nevison, a climate researcher, and Mark Blaxill, a former businessman and anti-vaccine
advocate, who together have published autism research that was later retracted. A
third presentation was given by Vicky Pebsworth, a nurse and ACIP member who
also serves as a board member of a leading anti-vaccine group. Pebsworth has a
son with autism who she believes
was harmed as a result of vaccinations as an infant.
Dr. Cody Meissner, a pediatrician and current ACIP
member, struggled to describe how distorted and off-base he thought the
presentations were, noting, “There were so many statements that I disagree
with, it’s hard to be succinct.”
The argument the presenters and the skeptics on the
committee tried to advance was that infants born to mothers who test negative
are at a low enough risk to not merit a routine recommendation. There was no
credible evidence presented proving that the birth dose is unsafe for infants,
so to make the case that the risks outweigh the benefits, the skeptics cast
doubt on existing safety studies and vaccine surveillance data, and
hypothesized about potential adverse effects that could have been missed. Hepatitis
B researchers criticized the presentations as inaccurate and misleading—one of
the authors of a referenced study told the committee during the meeting that
her work had been misconstrued.
It was clear that most members believed there was some
elevated level of risk from the vaccine, even if unknown and undocumented, and
that justified taking a “more humble” approach and rolling back the routine
recommendation in order to “do no harm.” Some members openly encouraged general
vaccine skepticism because of what they claimed was insufficient safety data.
“I suggest to parents to be very, very suspicious when people tell them that
something is safe, especially a vaccine,” said
Retsef Levi, a mathematician and MIT business school professor who backed the
recommendation.
Other members decried what they saw as a flimsy and
speculative basis for decision-making. “For many weeks now I have been
advocating in our committee that we have a scientific framework for making our
decisions,” Dr. Joseph Hibbeln, a psychiatrist, told
his colleagues. “No valid scientific frameworks were proposed.”
Hepatitis B researchers, doctors, medical associations,
and the handful of dissenting ACIP members panned the rollback of the
recommendation. The universal birth dose guidance and corresponding high uptake
among parents—an estimated 75 percent of
babies receive a birth dose—has led to a huge decrease in hepatitis B cases
contracted by infants and younger children. Significantly, the U.S. tried a
similar targeted approach in the 1980s to what the committee adopted last week,
recommending a newborn dose for mothers testing positive, but the strategy
still resulted in upwards of 16,000
hepatitis B cases annually in infants and adolescents.
Why were cases still so high? Doctors and researchers
point to a variety of factors, including imperfect screening and testing of
mothers. While universal prenatal testing for pregnant women has long been
recommended by ACIP, it’s not universal in practice—an estimated
12 to 16 percent of women do not receive testing. Screening is also often done
early in the pregnancy but not always again at the time of delivery, a window
during which a mother could unknowingly become infected. And although it’s
uncommon, the tests themselves can return false negative results.
There’s also the risk of transmission early in life from
interactions in the home or in daycare settings with other kids and adults who
do not know that they are hepatitis B-positive—half of adults with hepatitis B
don’t know they have the disease and can unknowingly spread it. Hepatitis B is
orders of magnitude more contagious than HIV, can live on surfaces for days,
and can be transmitted through even non-visible, specks of blood on things like
shared nail clippers or tooth brushes. After the universal recommendation in
1991, the documented number of infant and adolescent hepatitis B cases fell by
99 percent, and now the number is less than two dozen annually. Multiple
groups, including the Center for Infectious Disease and Research Policy
(CIDRAP) at the University of Minnesota, have documented
in detail the shortcomings of the narrowed recommendation and the subsequent
success of the routine recommendation.
“If you’re the one who wants to change guidelines, the
onus is on you to show that you have a suitable substitute for something that’s
99 percent successful,” Ault, the former ACIP member, told The Dispatch.
The added recommendation to wait till two months of age
before receiving an initial dose has even less plausible scientific basis. The
committee picked two months as a threshold simply because it’s further away
from birth but cited no information showing that a delayed first dose is any
safer than at birth. To the contrary, CIDRAP’s hepatitis B safety review
identified four studies that compared the birth dose to a first dose given at
one month, and none of the studies demonstrated any increased risk of adverse
events in babies who received the birth dose. “This specific point is the
reason we tabled this issue for three months to more fully discuss it,” Hibbeln
said
of the delay recommendation.“However, we have still not had any information or
science presented or discussed with regards to this issue before or after two
months of age. This is unconscionable.” Another committee member Raymond
Pollak, a surgeon and transplant specialist, agreed:
“If we’re here as a science-based committee, there is no data to support a
two-month recommendation.”
Blood test hypotheticals.
The committee also adopted an additional recommendation
suggesting that blood testing be used to assess antibody levels after an
initial vaccine dose to help parents decide if their children should complete
the full series of the hepatitis B vaccine. But there are no studies or data
showing that an antibody test can be used as an indicator that a child can take
an incomplete series of the vaccine and still receive long-lasting protection
from the disease. Meissner was astounded at the proposal, describing it as
“like never-never land” and “pulled out of the air.” CDC scientists urged
the committee that while this is something that could possibly be studied, it
should not issue a recommendation based on something entirely untried.
Dr. Robert Malone, the current ACIP vice chair who has
served as a paid
witness in lawsuits against vaccine manufacturers, and Levi, the management
professor, backed the proposal. While
the pair had repeatedly argued public health authorities need to be more humble
and not take risks based on insufficient data, they seemed satisfied with doing
just that when it came to the testing recommendation. Levi said
it was “reasonable to hypothesize” that antibody testing would work as an
indicator of lasting protection, and Malone said,
“As an experimentalist and trialist, I’m really intrigued by the possibilities
that this recommendation might open up,” adding later
on social media it will help “stop over vaccination.”
Public health vs. individual choice.
While the meeting surfaced little new information about
the hepatitis B vaccine, it did make clear that an ACIP remade in Kennedy’s
image now has a fundamentally different understanding of its job. Malone
signaled this when trying to articulate what he saw as the crux of disagreement
over the hepatitis B recommendation. “This topic seems to me to be right at the
center of that paradox between managing individual patients and focusing on the
rights and interests of that particular patient in front of you,” he said, “and
the interests of maximizing the greatest good for the greatest number that
drives public health policy. My personal bias is to err on the side of enabling
individual decision-making and individual rights over the collective.”
“It means that there are these two fundamental
differences of opinion about the rights of individuals versus the rights of
society and the goals and objectives of society. And it seems to me that is the
essence of what we’re dealing with,” he added. Dr. Kirk Milhoan, the ACIP
chair, echoed
the sentiment: “Some of us fall more on the side of patient, physician
decision-making and the others are looking at it from a public health
[perspective].”
The recommendation, said
Levi, “rejects the idea that vaccines in general, and this vaccine in
particular, should be used to mandate vaccination and coercion to vaccination
and condition attendance to educational settings or clinical care settings.”
Other members made similar statements, frequently bringing up whether parents
received enough information before giving their consent for vaccination. “I
don’t see how a universal policy is informed consent,” said
Catherine Stein, an ACIP member and tuberculosis researcher.
But multiple medical group liaisons
and CDC staff pointed out that the problem with that thinking is that ACIP
issues recommendations, not mandates, and nothing the committee decides can
take away informed consent or the right of anyone or any parent to refuse a
vaccine. “Making a recommended dose at birth does not in any way impede those
parents from being able to decline the vaccine at that point or any point or to
never vaccinate their child if that is their choice,” Dr. Laura Morris, a
liaison representing the American Academy of Family Physicians, said
during the meeting “They have that option with the recommendation the way that
it currently stands.”
If medical providers are not properly informing patients
and parents about benefits and potential risks before obtaining consent for
vaccination or not obtaining consent at all—as several committee members
argued, citing examples from their own lives and from people they’ve spoken
with—then that is a legal and compliance issue with individual hospitals and
practices. Ault, the former ACIP member, told The Dispatch that to the
extent lack of informed consent is an issue currently, ACIP’s new wording is
probably not going to change how providers obtain informed consent on the
ground.
Parents always have the ability to refuse vaccination for
their child regardless of whether an ACIP recommendation is categorized as
routine or shared-clinical decision making. States tie some of their school and
daycare vaccination mandates to ACIP recommendations and or the CDC vaccine
schedule, but no state mandates a hepatitis B birth dose.
“The committee was not, in that case, balancing public
health and individual rights at all,” Dorit Reiss, law professor at the
University of California San Francisco whose work focuses on vaccine legal
issues, told The Dispatch. She said that the members’ framing of the
vote as the individual versus public health “shows, at best, a misunderstanding
of the topic of discussion and what they’re doing.” Reiss agreed that while
people can experience problems with how their doctors conduct informed consent
around the birth dose and other vaccines, changing ACIP’s recommendations
wouldn’t address this problem, saying the committee’s “job is not directly
related to parental autonomy.”
Trust issues.
Jerome Adams, the surgeon general during the first Trump
administration, posted
on X that the panel’s recommendation change doesn’t solve the problem it
sought to fix: “A patient and provider education campaign would’ve been better,
and more widely accepted without further eroding public trust in HHS.”
Adam Langer, a career CDC scientist and specialist in
hepatitis B, told the committee that he agreed that mandates are problematic
but they have no bearing on the science of ACIP’s recommendations. “We have a
lot of challenges with our culture and our traditions in our country with
telling people what they must and must not do,” he said. “But that’s not what
we’re saying here. We’re saying at a population level this is what the science
shows is the best practice.”
Yet, after the meeting, Malone still described votes as a
victory for informed consent and against vaccine mandates, writing that the new
guidance “enable[s] parents/guardians to decide when or even if their children
should receive this product” and it “means that any HepB Vax mandate, anywhere
in the USA, is not consistent with the ACIP recommendation.” That logic makes
sense if you think of ACIP as the top of the pyramid of a coercive national
vaccine system that is leveraged to force mandates onto parents. But such
thinking confuses causation for correlation. States use ACIP recommendations
and the CDC vaccine schedules to inform mandates because they see the guidance
as a reliable authority on vaccines. As the committee has become more defined
by vaccine skepticism, state mandates haven’t changed, but more
than 20 states have started turning to other medical advisory groups they
view now as more credible sources of vaccine guidance than ACIP and the CDC.
A key takeaway from last week seems to be that the
committee isn’t so much concerned with making what it sees as the best
population-level recommendation for each vaccine on the schedule—in fact, some
members appear averse to the very concept of routine recommendations. Instead,
the vaccine iconoclasts seem more focused on using the platform of ACIP to
protest how medical providers address vaccine skepticism in practice and
state-level vaccine mandates, neither of which the committee has control over.
With the president directing
the Department of Health and Human Services and the CDC to review the entire
childhood vaccine schedule and an ACIP work group already beginning to review
other vaccines, it’s likely we’ll see this process repeated again. The latter
effort was kicked off Friday during the meeting with a presentation on safety
studies from Aaron Siri, a lawyer whose firm has sued vaccine manufacturers.
Republican Sen. Bill Cassidy, the lawmaker whose vote
advanced Kennedy’s nomination as HHS secretary, said Siri’s
inclusion in the meeting showed that “ACIP is totally discredited.” Cassidy, a
liver doctor who has treated patients with hepatitis B, urged the CDC director
to not adopt the committee’s new hepatitis B guidance.
“Ending the recommendation for newborns makes it more
likely the number of cases will begin to increase again,” he said.
“This makes America sicker.”
No comments:
Post a Comment