ACIP & Measles & Influenza, oh my!

Welcome to my first Substack post—arriving on a day when:

• The ACIP meeting for next week has been indefinitely postponed

• Texas is facing its worst measles outbreak in over 30 years

• Influenza is everywhere—my patients have it, my family has it, and if my dog had it, I wouldn’t be surprised (kidding, zoonotic disease experts—I know that’s rare).

So instead of a formal introduction, I’ll save that for the bottom and jump right in.

The ACIP Meeting Was Postponed—What’s Going On?

The Advisory Committee on Immunization Practices (ACIP) is one of the most important public health committees in the U.S. That’s why today’s news—this month’s meeting being indefinitely postponed—is so concerning.

What’s the big deal? Does this actually matter?

Well, that depends. Is this just chaos from a leadership transition, or is something more going on?

On next week’s “postponed” agenda were just a few minor topics, like vaccines for:

• Meningococcus

• RSV

• HPV

• Pneumococcus

• Lyme disease

• Influenza

(Yes, that’s sarcasm.)

The real concern? This could signal the beginning of an overhaul of the ACIP driven by a non-evidence-based agenda. If that happens, the consequences would be catastrophic—not just for vaccine policy but for public health as a whole.

What Is the ACIP, and Why Does It Matter?

The ACIP is a nonpartisan, expert-driven committee that provides evidence-based vaccine recommendations. Their work directly affects:

• The childhood and adult immunization schedules

• Vaccine coverage for Medicaid, Medicare, and private insurance

• Protection against outbreaks, pandemics, and emerging threats

Without the ACIP—or with a politically reshaped version—the U.S. would face serious public health risks:

• Vaccine recommendations could become fragmented and inconsistent. Individual states and agencies could create conflicting guidelines, leaving providers and the public confused.

• Trust in vaccine guidance would erode. A new ACIP, under different leadership, may not operate with transparency or rigorous data review, opening the door for political interference and misinformation.

• Insurance coverage for vaccines could become chaotic. ACIP recommendations dictate which vaccines must be covered under the Affordable Care Act and other insurance programs. Without them, insurers could drop coverage, making vaccines unaffordable for many families.

• Outbreaks of preventable diseases would skyrocket. Infectious diseases don’t respect borders. If ACIP’s role is weakened, measles, pertussis, and even polio could make a full comeback. If vaccination rates drop in your community, it’s not a question of if, but when these diseases return.

The ACIP also plays a significant role in global vaccination efforts, even though its primary focus is on U.S. vaccine policy. Here’s how:

• Sets a Global Standard: Many countries consider ACIP recommendations a trusted, evidence-based framework for their immunization policies.

• Helps Global Health Policies: The WHO and other global health organizations monitor ACIP decisions when formulating their vaccine guidance. ACIP’s work often aligns with or informs the Strategic Advisory Group of Experts on Immunization (SAGE), which makes vaccine recommendations for low- and middle-income countries.

• Approved Vaccines Often Become Global Standards: When the ACIP endorses a new vaccine it helps build international confidence in its safety and effectiveness.

If the ACIP is dismantled or reshaped around a non-evidence-based agenda, this isn’t just a bureaucratic shift—it’s a worldwide public health disaster in the making.

Texas Measles Outbreak—A Preventable Crisis

If you think this is all a little alarmist, look no further than Texas, where the worst measles outbreak in over 30 years is unfolding in real-time.

As of today, 58 cases have been confirmed in the worst measles outbreak Texas has seen in over 30 years, and hundreds more are likely undiagnosed. The outbreak has now spread into New Mexico. The saddest part is that this should never happen. Every illness, hospitalization, and the millions of dollars that will be spent containing this outbreak were entirely preventable—with vaccines.

Measles outbreaks happen when communities are undervaccinated. While vaccine hesitancy plays a role, lack of access remains a huge issue, especially in rural areas. That includes not just access to vaccines themselves but access to trusted healthcare professionals who can answer parents’ questions and advocate for immunization.

Before blaming parents in these outbreaks, remember: Vaccine disinformation and cynicism prey on normal parental anxieties. I am sure these parents want their kids to be healthy—they just got caught in a web of bad information.

A year ago, I wrote this article about the tragedy of measles outbreaks in the U.S. because they are entirely preventable. Unfortunately, we are now living that reality again.

Influenza is Everywhere —And It’s Not Too Late To Get Vaccinated!

No, the map below isn’t a weather forecast (though I wish it were warmer).

Flu activity may have peaked, but it’s still widespread. I am seeing a lot of patients with influenza and they are miserable, especially those who haven’t been vaccinated! Sadly, pediatric flu deaths continue to rise. And, many of these are preventable.

If you haven’t gotten your flu shot yet, it’s not too late! Just next year, get it earlier.

Is the flu vaccine perfect? No.

Does it significantly reduce your risk of severe illness, hospitalization, and death? Absolutely.

A Little About Me

There are others with more experience in vaccine development, epidemiology, or infectious diseases I follow—and I encourage you to do the same. I don't want to add to the noise in a world where everyone has an opinion on everything. My perspective on vaccines, public health, and prevention is unique as a practicing pediatrician, a community health services researcher focused on vaccine communication and delivery, an academic physician who loves teaching, a board-certified public health physician with experience across local, state, and national levels, and someone with a background in basic science (yes, I can nerd out on data and esoteric science with the best of them, although my pipetting skills are long gone).

I firmly believe partnership, empathy, and compassion go further than shouting at each other. That doesn’t mean I won’t take a stand when something threatens public health—it just means that when I do, you’ll know how serious the threat really is.

The same goes for comments—constructive discussions are welcome, but shouting isn’t. I won’t always get everything right, and when I rethink something, I’ll be the first to admit it.

If you’re as concerned as I am about the future of vaccination in the U.S. and evidence-based vaccine policy, stick around. Let’s navigate this together.