CDC panel overhauled by RFK Jr. changes childhood vaccine recommendations

William Brangham:

The Advisory Committee on Immunization Practices began a two-day meeting today to discuss and vote on various recommendations. It's being watched closely because the committee was completely overhauled by Health Secretary Robert F. Kennedy Jr. when he fired the previous members and replaced them.

On the agenda, big questions about vaccines for hepatitis B and the measles, mumps, rubella and varicella.

Ali Rogin has more.

Ali Rogin:

That's right, William.

Today, the committee met and took its first votes towards changing the schedule for childhood vaccines. Just a short time ago, the committee voted to recommend against children under the age of 4 getting the combined measles, mumps, rubella and varicella vaccine. While many kids don't get the shot that way, it was part of a larger conversation today about limiting access to some vaccines for some children.

Joining me now to discuss the meeting is Dr. Tom Frieden, president and CEO of Resolve to Save Lives and former CDC director under President Obama. He's also the author of the forthcoming book "The Formula for Better Health: How to Save Millions of Lives, Including Your Own."

Dr. Frieden, thank you so much for joining us.

What is your reaction to the changes that ACIP was discussing and voted on today?

Dr. Thomas Frieden, Former Director, Centers for Disease Control and Prevention: There are a few things that were clear from today's meetings. The first, which was reassuring, was that the CDC staff presentations were extremely high-quality. They were what we have seen for year after year, where we have some of the best vaccine scientists who dedicate their lives to protecting kids presenting really good information about what works and what doesn't.

That was encouraging. Less encouraging was the kind of questions and discussions from the current members of the committee, some of whom were very clear and very focused and scientific, some of whom seemed to dismiss data and say, it's not about the data, it's about trust, it's about safety, it's about concerns.

So the process was concerning. The voting was actually quite confusing, so much so that one of the members abstained because he didn't — he — it wasn't clear what was being voted for. It's very technical, but what got decided today was basically that there are two ways for young kids to get their first dose of one of the vaccines.

You can either get them as one shot or two. Currently, about 85 percent of kids get them as two shots because the one shot has the advantage that you have one less shot, and the disadvantage that it carries a small risk of febrile seizures, which are scary, but generally benign.

The committee voted not to recommend that option be given to parents. So it wasn't about recommending a change. It was recommending that this option, which parents had before, not be an option. But it was then voted that, even though the ACIP had recommended that, it should be covered by one of the ways that half of American kids get their vaccines, what's called the Vaccines for Children Program, which covers about 36 million kids in this country.

So it was a confusing day. I think the bigger decision will come tomorrow on hepatitis B. That's a much bigger deal.

Ali Rogin:

And speaking of hepatitis B, this is very much in the air. There have been conversations today. The vote will be held tomorrow, but, as you mentioned, ACIP is looking at changing the guidelines against all newborns receiving the hepatitis B vaccine at birth, which is currently the recommendations.

Members of this committee argued that not all newborns need it and that the focus can be more on screening pregnant mothers for the hepatitis B virus prior to giving birth. What's your take on all of this?

Dr. Thomas Frieden:

Yes it is said that Yogi Berra said, in theory, theory and practice are the same. In practice, they're different.

We tried this. It doesn't work. Without a universal recommendation, you miss too many kids. It's a safety net. People say, well, what about a woman who tests negative? Well, hepatitis B, unlike HIV, is quite transmissible. You can get it from a cut. You can get it from a toothbrush.

And so even if a woman who's pregnant tests negative, she may later test positive, or the infant may be infected. Now, if everyone in the family is negative and they want to not get a vaccine for some time, there's no negative to getting the vaccine. And it's very effective at protecting.

To give you a sense of this, before this policy, about 20,000 kids a year in this country got infected during or after birth. And that's really bad, because a quarter of them will be killed by this infection with liver cancer or liver cirrhosis. With this policy, that number has come down about 90 percent to 1,000 or 2000 kids get the infection.

So we're talking about a change that could result in hundreds of American kids dying. This would be a mistake.

Ali Rogin:

Speaking about the confusion you mentioned before when it comes to this combined measles, mumps, rubella, and varicella vaccine, it actually seemed at the end of the meeting like they might revisit one of the two votes they took on this, the result of which seemed to set up a two-tier system where some children on some insurance plans might have access to this combined vaccine and others who benefit from a fund called Vaccines for Children, which provides many vaccines, may in fact have access to it.

What does this all mean for members of the public who right now are looking to the CDC and ACIP for guidance?

Dr. Thomas Frieden:

Well, it's interesting that the insurer association put out an announcement a couple days ago that they weren't going to follow what this ACIP does, this advisory committee does, because they really have lost the trust. It's a huge vote of no confidence in this process, and that's unfortunate.

I think, stepping back, you have to look at what this administration, and particularly Secretary Kennedy, is doing, rather than what he is saying. He's saying he wants to restore trust. He just destroyed trust of the insurers. All of the major medical societies have diverged for the first time really from HHS recommendations.

But for the general public, this isn't a big change as of today, but you have to watch what happens next. What happened a few weeks ago was completely without any process. There was a change in the recommendations for the COVID vaccination, which has made it much harder for healthy young adults to get vaccinated. And this is really unfortunate.

So, again, look at what they're doing, not what they're saying. Secretary Kennedy said he's not going to take away anyone's vaccines, but he made it way harder for millions of Americans who want to get vaccinated against COVID to get vaccinated.

Ali Rogin:

That's former CDC Director Dr. Tom Frieden.

Thank you so much.

Dr. Thomas Frieden:

Thank you.