In medicine, when a patient’s vital signs fluctuate, we do not declare the crisis over because one number temporarily looks better. We look at the whole clinical picture. We examine trends. And, above all, we stay focused on the evidence.
The clinical picture for vaccine policy in the United States suddenly seems more confusing than at any point in the past year. On Monday, a federal judge in Boston blocked the US Department of Health and Human Services’ (HHS) newly weakened childhood immunization schedule and indicated that HHS Secretary Robert F. Kennedy Jr. likely violated federal rules when he fired and replaced the members of the CDC’s Advisory Committee on Immunization Practices (ACIP).
The rulings were unequivocally good news for children’s health, but the judge’s opinions are unlikely to be the final word in the case.
The judge’s opinions are unlikely to be the final word in the case.
Meanwhile, recent news reports include an HHS leadership shakeup and stories that the White House wants to shift focus away from the department’s unpopular vaccines’ agenda. Those reports have been accompanied by the cancelation of an autism-focused HHS committee meeting and an agenda change for the now-scuttled ACIP meetings that had been scheduled to start today, dropping a previous plan to vote on COVID vaccine recommendations. Finally, when the acting CDC director promoted the measles, mumps, and rubella vaccine at a time of record-breaking measles infections, it was notable enough that it generated news coverage.
No indication of a substantive course correction
Medical and public health leaders must resist the temptation to read all this news as a change in the overall clinical picture—ie, a substantive, durable course correction to the state of vaccine policy. That’s a bad bet. A personnel adjustment is not a policy reversal. An agenda edit does not mean the department’s agenda has improved. They are tactical maneuvers likely to last only through November. Meanwhile, the court ruling will almost certainly be challenged.
The most important factors affecting the vital signs for federal vaccine policy, which we count on to help protect our country from vaccine-preventable diseases, are largely unchanged and continue to be dire: Kennedy is still leading HHS. Anti-vaccine advocates continue to hold senior roles within the CDC, and although ACIP is in limbo its appointees are a court ruling away from being back in business.
HHS has already weakened the traditional guardrails of evidence-based vaccine recommendations and sown doubt about the safety and effectiveness of vaccines, putting children’s health at greater risk.
HHS has already weakened the traditional guardrails of evidence-based vaccine recommendations and sown doubt.
To overhaul the childhood immunization schedule, the agency bypassed expert review to remove longstanding recommendations for influenza, rotavirus, hepatitis A, hepatitis B, and COVID-19 vaccines from the routine schedule—moves that departed from decades of accumulated safety and effectiveness data. We’ll now wait to see what the courts say about the judge’s ruling, which put that schedule, for now anyway, on ice. In addition to weakening the immunization schedule, the department has also sidelined or restructured advisory processes, reduced transparency around evidence reviews, and signaled skepticism toward established vaccine safety monitoring systems.
These are not symbolic gestures; they are structural changes that affect how evidence is gathered, weighed, and translated into guidance for clinicians and families.
A need for continued vigilance, urgency
That’s why those of us involved in efforts to preserve evidence-based vaccine recommendations—medical specialty societies, independent public health and academic organizations, and state coalitions—can’t take our foot off the gas.
It’s time to intensify efforts. That’s what we’re doing at the Vaccine Integrity Project.Last year we reviewed immunization evidence for the respiratory virus season and the hepatitis B birth dose, both of which underwent peer review, demonstrating transparency and high-quality science.
This year, we continue that work on three separate immunization reviews designed to provide the most up-to-date view of the safety and effectiveness of key vaccines. We do this work in collaboration with medical specialty societies who are drafting immunization recommendations to support health care providers and the general public.
Disease is not on hold. We can’t afford to be, either.
The uncertain pause in federal efforts to sow doubt on vaccine safety and effectiveness and limit their use is an opportunity to solidify the gains that independent groups and medical societies have made over the past year to establish structures and processes that fill many of the responsibilities that our government used to perform.
Historically, ACIP’s strength derived not only from its statutory authority but from the credibility of its process. That credibility was earned through transparency, methodologic rigor, the demonstrated qualifications of its members, and insulation from political pressure. If those attributes continue to be eroded, they must be preserved elsewhere until they can be restored.
Disease is not on hold. We can’t afford to be, either.
Vaccine Integrity Project Viewpoints are authored by project staff and advisers. They are intended to address timely issues regarding vaccines with straight talk and clarity by presenting facts to counter falsehoods.
