The ACIP Meetings Matter More Than You Think
Why vaccine policy debates aren’t just political theater—they show up in exam rooms, shaping what parents hear and how children are protected.
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Last week in clinic, new parents told me, “We want to wait until our daughter is 12 years old to get the hepatitis B vaccine.”
I had a good idea where that came from, but instead of jumping in, I stayed curious and asked them to tell me more.
They said, “Well, the President recommended it, and he has scientists and people who know what’s best.”
After a brief conversation, the family came to understand that, in fact, he was not speaking from scientific evidence. And once that was clear, they asked for their baby to receive the hepatitis B vaccine.
This conversation highlighted the distance between policy debates and real families trying to make the best decisions they can. It also illustrates why the next Advisory Committee on Immunization Practices (ACIP) meeting, scheduled for December 4-5, matters so much.
Let’s take a closer look at what the ACIP plans to discuss and the messages those agenda items will send.
What We Know—and Don’t—About the Agenda
In December, the ACIP—an advisory body meant to provide independent, conflict-free vaccine guidance—will reportedly discuss two topics:
The hepatitis B vaccine.
This was already discussed at the September meeting. A planned vote for that meeting, focused on the birth-dose recommendation, was abruptly tabled without clear justification. The hepatitis B vaccine is supported by some of the strongest evidence in the vaccine schedule. The postponed vote in September suggests that either members realized they had insufficient evidence to justify changing long-standing recommendations, or there was political pressure on a process that is supposed to be independent, transparent, and science-driven.
Vaccine safety and the childhood and adolescent immunization schedule.
This topic is about as broad and vague as an agenda item can be. But the newly created Childhood and Adolescent Immunization Schedule Workgroup, which will inform the committee’s discussions, gives us insight. Their stated focus includes timing and order of vaccines, safety of giving multiple vaccines together, safety of ingredients, and comparisons between U.S. and international schedules. These questions have been continually reviewed through extensive surveillance data and decades of safety research.
So, what’s different now?
The framing and the people doing the framing—not the science.
And this matters, because for pediatricians in clinic, these decisions aren’t abstract. The guidance families trust us to provide can literally be life-or-death for children. To the best of my knowledge, no current ACIP voting member is an actively practicing pediatrician. That means nobody on the committee is carrying the weight of those real-time decisions in clinic every day.
Behind the Agenda
As the meeting gets closer, more details will inevitably emerge. However, focusing solely on the topics overlooks the broader narrative.
The “questions” being raised aren’t actually new. They’re old questions being pulled off the shelf and repackaged as if they’ve never been examined. The point is to create the appearance of doubt where consensus already exists.
When your influence has grown by questioning established systems, it’s difficult to stop once you’re in charge. Contrarian voices often rely on continual questioning as a strategy to challenge existing structures—not necessarily to reach better answers, but to keep everything unsettled.
Science also depends on questions, but scientific questions must be asked with great care and follow the evidence, rather than being used to manufacture doubt.
Meanwhile, institutions need answers. Translating science into policy requires taking the questions that have been answered by science—with varying levels of certainty—and turning them into actionable decisions, allowing real-world work to be done.
Sowing doubt consumes time that should be spent on addressing real uncertainties, strengthening access, or evaluating new vaccines, and it adds confusion for parents and the public.
The Exam Room Is Where This Lands
Most people will never watch an ACIP meeting. Some may skim a headline, but almost no one is reading the technical details or meeting transcripts.
Yet the effects reach all the way into exam rooms.
The family I saw last week wasn’t acting out of mistrust or defiance. They were acting on messages.
The ACIP’s actions send a different kind of message into the world—one that lands in anxious parents’ heads, already bombarded with social media claims and false ideas:
“Maybe something changed.”
“Maybe this isn’t settled after all.”
“Maybe you should wait.”
But with vaccines, “waiting” isn’t neutral. Delaying means missing the window when children are most vulnerable—and when the vaccine is most protective.
And it’s why what happens at ACIP meetings matters not just for national policy. It matters in exam rooms across the country, with clinicians caring for children and families who are simply trying to make the best decisions they can—like the family I met last week.
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-David
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Thank you for this. You captured something that many people outside medicine don’t see clearly enough. These ACIP discussions are not abstract policy debates. They land directly in exam rooms and shape the decisions real families make. I especially appreciated how you showed that “waiting” is not neutral and that old, long-answered questions are being repackaged to create doubt rather than clarity. Your insight about the absence of actively practicing pediatricians on the committee is important and not widely recognized. This was an excellent and timely piece.
Your example with the hepatitis B vaccine conversation is so powerfull. The gap between policy debates and what happens in exam rooms is real, and it's healthcare providers who have to bridge that divide. The Childhood and Adolescent Immunization Schedule Workgroup examining questions that have already been extensivley studied through decades of surveilance data really is the defintion of manufacturing doubt.