By Lisa Jarvis / Bloomberg Opinion
Robert F. Kennedy Jr.’s decision to oust the Center for Disease Control and Prevention’s entire panel of outside vaccine advisers is at once utterly shocking and entirely predictable. Every new action by the secretary of Health and Human Services seems more impudent than the last; all in service of undermining confidence in some of our most reliable public health tools.
The magnitude of his dismissal of all 17 members of the Advisory Committee on Immunization Practices (ACIP) — an independent panel of experts that makes recommendations on vaccine deployment in the U.S. — is unlikely to register with the public. After all, this is a wonky committee that only fleetingly entered the public consciousness during the covid-19 pandemic, when everyone anxiously awaited its verdicts on the first vaccines. But Americans will feel the effects of Kennedy’s decision in their everyday lives; and it will happen sooner rather than later.
Kennedy’s maneuver had been signaled for months. He showed his hand during his confirmation hearings when he refused to say that vaccines do not cause autism. He showed it again during his first weeks in office when he refused to strongly advocate for measles vaccination amid an outbreak in Texas. He revealed it when he ousted the Food and Drug Administration’s top vaccine official. He also did it when he launched an investigation into the cause of autism, appointing a notorious anti-vaccine activist to comb through government data. And he did so yet again when he unilaterally announced new restrictions on covid vaccines.
However, all that was just the warm-up for this week’s showstopper. Kennedy justified the move in a Wall Street Journal op-ed, where he said the committee “has been plagued with persistent conflicts of interest and has become little more than a rubber stamp for any vaccine.” Kennedy based that claim on old, flawed reports. In fact, committee members are thoroughly vetted and routinely recuse themselves from decisions that might present a conflict.
The panel’s dismissal “will upend everything that is normal and science-based around vaccine policy making in the United States,” says Richard H. Hughes IV, a lawyer with Epstein Becker & Green PC and a former executive with the vaccine manufacturer Moderna.
Public health experts had been worried about this possibility since Kennedy’s nomination was announced. It’s a discretionary committee, so he has full control of its membership; even its existence, Hughes explains.
Republican Sen. Bill Cassidy, a physician and advocate for childhood vaccines from Louisiana, had specifically addressed those concerns during Kennedy’s confirmation hearings. However, Cassidy voted to confirm him anyway — despite Kennedy’s underwhelming performance — based on a list of assurances he’d been given. Those included a promise to “work within the current vaccine approval and safety monitoring systems, and not establish parallel systems,” and “maintain the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices without changes.”
Kennedy now has broken both promises. What does Cassidy have to say about it?
“Of course, now the fear is that the ACIP will be filled up with people who know nothing about vaccines except suspicion. I’ve just spoken with Secretary Kennedy, and I’ll continue to talk with him to ensure this is not the case,” Cassidy posted on X.
That’s not exactly reassuring given the outcome of Cassidy’s previous talks with the secretary.
Just last week, Kennedy’s legal adviser — known for his extreme anti-vaccine views, including asking the Food and Drug Administration to revoke its approval of the polio vaccine — posted a list of suggested groups to add as non-voting members to ACIP on X. Unsurprisingly, they all have alarming histories on vaccines.
Meanwhile, an HHS statement announcing the change indicates that an ACIP meeting scheduled for later this month — one where the committee will consider recommendations for covid, flu, RSV and HPV vaccines among others — will go on as planned. That indicates that Kennedy has already handpicked the people who will occupy this important role and suggests they will not go through the months of careful vetting typical for this appointment.
ACIP’s recommendations have significant consequences for the public’s access to vaccines. Although the FDA is responsible for reviewing the data and deeming shots sufficiently safe and effective to be marketed, the CDC panel lays out how they should be used. Those guidelines, in turn, determine whether they must be covered by insurance. And while private insurers might opt to pay for shots that don’t make ACIP’s list, Medicaid and Medicare are more restricted.
In other words, if the committee makes changes, say, to the childhood vaccination schedule or for recommendations on who should get covid vaccines, the impact will be indirect but potentially significant. In theory, a person might still be able to get a particular vaccine, but in practice, might miss out because they can’t afford it, or because it might be harder to find a provider offering it.
The deep irony, says Matthew Motta, an assistant professor of Health Law, Policy & Management at Boston University’s School of Public Health, is that Kennedy and Trump have pushed for personal choice in health care; especially in vaccinations. And yet, “this is taking the personal choice element out of it, because if you can’t afford to vaccinate — even if you want it — your personal choice has been made for you by the government,” he says.
The other obvious concern is how a potential shift in government messaging on vaccines will affect public sentiment;and widen the political divide on the topic. Even as pockets of the country have become entrenched in vaccine skepticism over the years, the majority of Americans have continued to support routine childhood vaccinations. Until recently, that is. Survey data show Republicans’ confidence in the shots is weakening. It’s not hard to imagine those data looking a lot worse a year or two from now, and that the deepening divide will persist long after Kennedy is out of office.
Every new move by Kennedy ratchets up the stakes for the health of Americans and makes it harder to undo the damage.
Lisa Jarvis is a Bloomberg Opinion columnist covering biotech, health care and the pharmaceutical industry. Previously, she was executive editor of Chemical & Engineering News.
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