Last week in Atlanta, the usually staid world of public health was upended as the Advisory Committee on Immunization Practices (ACIP) convened under extraordinary circumstances. The committee, responsible for shaping the nation’s childhood vaccine schedule, met at a satellite campus of the Centers for Disease Control and Prevention (CDC)—their headquarters still bearing scars from a deadly shooting just a month earlier, an act reportedly motivated by vaccine-related grievances, according to KFF Health News.
The meeting, held on September 18 and 19, was the first major test for a radically reconstituted ACIP. In June, Health and Human Services Secretary Robert F. Kennedy Jr. fired all 17 previous committee members, restocking the panel with 12 new appointees, many of whom are outspoken vaccine critics. This reshuffling, as reported by KFF Health News and echoed by The Atlantic, has sent shockwaves through the public health community and ignited fierce debate over the future of vaccine policy in the United States.
From the outset, the new ACIP’s inexperience was palpable. “We are rookies,” admitted Martin Kulldorff, the committee’s chair and a biostatistician, acknowledging the group’s limited grasp of the technical issues at hand. The panel’s discussions revisited scientific questions about vaccines that, as Paul Offit of Children’s Hospital of Philadelphia noted, had been settled decades ago. Offit likened the proceedings to a children’s mock United Nations, only with real-world consequences.
One of the most contentious topics was the long-standing recommendation that newborns receive a hepatitis B vaccine before leaving the hospital—a policy in place since 1991. Some panelists, including MIT professor Retsef Levi, questioned the need to vaccinate healthy infants from “normal” households, suggesting that targeted vaccination might suffice. However, CDC scientist Adam Langer explained that previous attempts to limit vaccination to high-risk groups had failed to control the disease, and that universal newborn vaccination had proven essential to reducing hepatitis B infections. “As time goes on, the people who benefited from the change in policy at the very beginning of the policy are moving into different age groups,” Langer patiently stated, according to KFF Health News.
Despite the evidence, the debate was muddied by calls from some members for placebo-controlled vaccine trials—a practice considered unethical, as it would require withholding proven protection from children. Others cited outlier studies from countries with vastly different health systems and conditions, while nurse Vicky Pebsworth, representing the National Vaccine Information Center, read off selective research to argue against vaccine safety. The familiar refrain of “too many, too soon” was wielded by both skeptics and defenders, with Judith Shlay of the National Association of County and City Health Officials noting that splitting combination vaccines could actually increase the number of injections children receive.
The panel’s confusion was on full display during a vote on whether to recommend the combined MMRV shot (measles, mumps, rubella, and varicella) or separate vaccinations. The committee initially voted 8-3 for separate shots, only to revisit and reverse the decision the next day after realizing the implications had not been fully understood. As The Atlantic recounted, the session was so chaotic that at one point, an open microphone picked up a panelist muttering, “you’re an idiot,” during Levi’s remarks. “This way of doing things is rushed and sloppy,” said Adam Ratner, author of Booster Shots, lamenting the move away from rigorous, standardized evaluation of evidence.
Behind the scenes, the drama extended beyond the committee room. Just days earlier, former CDC director Susan Monarez and former CDC medical director Debra Houry testified before the Senate Health, Education, Labor and Pensions Committee about being sidelined or ousted by Kennedy for resisting his push to change vaccine recommendations. “I was fired for holding the line on scientific integrity,” Monarez told senators, describing intense pressure to endorse Kennedy’s preferred changes and to communicate only with his political appointees. Houry resigned in protest after Kennedy’s aides reportedly forced the hepatitis B discussion onto the ACIP agenda, according to her testimony and reporting by KFF Health News.
The upheaval at the CDC has not gone unnoticed by state officials. On September 21, Maryland joined other Northeastern states in forming a new public health coalition with the authority to make its own vaccine recommendations, a direct response to what regional leaders see as a federal retreat from evidence-based policy. This coalition, as reported by The Baltimore Sun, is positioned as a counterweight to the vaccine policies promoted by Kennedy and former President Trump.
Meanwhile, Kennedy has continued to stoke controversy. On Fox News, he announced that the National Institutes of Health (NIH) is launching studies into whether psychiatric drugs, including SSRIs, might contribute to violence—a move that has drawn skepticism from mental health professionals and added to the sense of uncertainty surrounding the nation’s health leadership.
For many in the scientific community, the recent ACIP meeting represented a dangerous departure from established norms. Stanley Plotkin, the renowned vaccine developer, wrote to Levi, “Please consider whether your grasp of immunology and public health is sufficient to make recommendations that will result in more disease. Modesty about your basic knowledge would help.” The Atlantic further reported that CDC scientists were largely shut out of meeting preparations, with resolutions and supporting materials not posted in advance and unvetted studies cited during deliberations.
The consequences of this upheaval are already being felt. The likely decline in use of the combined MMRV shot, the confusion over hepatitis B recommendations, and the broader erosion of trust in public health agencies all point to a period of uncertainty and risk. As Sean O’Leary, a pediatrician and former ACIP liaison, observed, “The whole purpose of the people on this committee is to circulate these old recycled anti-vax talking points.”
Yet, amid the chaos, some voices urged caution and continuity. Cody Meissner, a Dartmouth College professor and longtime vaccine researcher, argued that efforts to narrowly target vaccination would inevitably miss vulnerable children. “The more we try and define a target group to vaccinate, the less successful we are,” he said, underscoring the practical realities of America’s fragmented health system.
In the end, the committee postponed its vote on the hepatitis B birth dose, avoiding—for now—a drastic reversal of a successful public health campaign. But the episode has left many wondering what comes next. Will the chaos unleashed by Kennedy’s leadership continue to undermine the nation’s vaccine infrastructure? Or will states, scientists, and public health advocates find ways to restore trust and stability?
For now, the future of childhood vaccination in the U.S. remains uncertain, caught between competing visions of science, policy, and parental trust. What’s clear is that the stakes—for children, families, and the country—could not be higher.
