The Vaccine Brief: ACIP Disbanded and the Chaos of COVID Vaccine Policy
What Matters This Week, June 9
I’m David Higgins, a practicing pediatrician and preventive medicine physician who cares for children, adolescents, and their families and studies how to improve how we communicate about and deliver preventive care and vaccines. This newsletter shares clear science, smart policy, and meaningful conversations, because the health of our communities depends on all three. If you haven’t already, hit the button below to stay in the loop with updates.
Hi community,
I was about to send the post below when I learned that RFK Jr. disbanded the CDC’s ACIP—the expert committee that has guided U.S. vaccine recommendations for over 60 years, citing vague and unsubstantiated claims of conflict of interest.
This is an unprecedented move. Accountability and transparency in vaccine policy are essential, but “a clean sweep” of this advisory body, without clear justification, a transparent process, or a viable replacement, is dangerous. And it will not build trust. Even if qualified members are quickly appointed, public confidence in the ACIP and the broader vaccine system may already be seriously undermined.
Actions like this have consequences that will ripple through every community, regardless of who you voted for, where you live, or what you believe. But my deepest concern is for those whom I and so many others have devoted our careers to and sacrificed so much of our lives to protect: our children, their families, and the most vulnerable among us.
Those of us who have held a child in the grip of a tetany spell, watched a newborn gasp between body-wracking pertussis coughs, or cared for a child who walked into the ER with influenza and never walked out, we know what’s at stake. These are life-and-death decisions.
Leaders can disregard science, but eventually their policies will meet infectious diseases that won’t. And when that happens, the lives lost or forever altered will be a tragic legacy of those who enabled it.
We must demand that our leaders ground health policy in established science, transparency, and an unwavering commitment to protecting all Americans, especially the most vulnerable.
I’m sharing the rest of this post without re-writing it because it illustrates what happens when life-altering decisions for millions of Americans are made hastily, bypassing the expertise, safeguards, and processes designed to protect the public from harm. There will be plenty more to discuss regarding the move to disband the ACIP, look for more to come…
If you’re confused about COVID-19 vaccine guidance, you’re not alone. In the past two weeks, we’ve seen a tangle of announcements, contradictory updates, and an unprecedented policy reversal by HHS, all of which have left clinicians, public health leaders, and even vaccine experts scrambling for clarity.
I delayed reacting to every twist and turn to let the dust settle (oh, how naive of me). I want to walk through what happened and why it’s all so confusing.
Quick Primer: Who Does What?
The FDA, guided by its independent advisory committee (VRBPAC), approves vaccines based on safety and efficacy data.
The CDC, guided by its advisory committee (ACIP), recommends how and for whom vaccines should be used.
The HHS Secretary oversees the FDA and CDC, but rarely intervenes directly or unilaterally.
A Timeline of Recent COVID-19 Vaccine Recommendations
May 20
In a New England Journal of Medicine editorial, FDA commissioners Makary and Prasad announced a major regulatory policy shift: COVID-19 vaccines would be recommended only for adults aged 65 and older or those at high risk, with new clinical trials required before authorizing vaccines for healthy adults under 65. In this article, they specifically include pregnancy in the list of underlying conditions that increase a person’s risk of severe COVID-19. To be clear, the FDA approves vaccines, and the CDC makes recommendations.
May 22
The FDA’s Vaccines and Related Biological Products Advisory Committee (VRBPAC) met to consider recommendations for the 2025-2026 formula of COVID-19 vaccines. During the meeting, even VRBPAC members did not know how or if the FDA’s new regulatory framework would impact their decisions.
May 27
In a move that stunned the public health community, HHS Secretary Robert F. Kennedy Jr. announced via Twitter/X that COVID-19 vaccines “have been removed from the CDC’s recommended immunization schedule” for healthy children and pregnant women. He was joined by NIH Director Jay Bhattacharya, who called the move "Common sense and good science," and FDA Commissioner Marty Makary, who stated, "There is no evidence healthy kids need it today." This recommendation seems to contradict the newly announced FDA regulatory framework published 7 days earlier, highlighting pregnancy as a high-risk condition.
We wrote more details about this over at
:
May 29
The CDC website was updated with new immunization schedules.
For pregnancy, these new schedules removed the recommendation for a “No Guidance/Not Applicable” guidance. However, for several days, if you hovered over the grey box online, a box popped up saying, “Delay vaccination until after pregnancy if vaccine is indicated.” I have it on good authority that this was an honest mistake and has since been fixed. However, this incident underscores how skipping normal processes, cutting staff, and rushing decisions can lead to more errors.
For healthy children, instead of “No Guidance/Not Applicable” guidance, the new schedule has a recommendation for shared clinical decision-making (SCDM), which is indicated by a blue “See Notes”. This appears to be different than what was announced by Twitter/X, which adds to the confusion, but it is a welcome change.
For healthy adults, the vaccine schedules have not changed at this time.
June 25-27
The ACIP is scheduled to meet in just a few weeks, with COVID-19 vaccines on the agenda and a vote expected on recommendations for specific groups. While ACIP makes evidence-based recommendations, it is ultimately up to the CDC—and, in this case, without an acting CDC director, HHS—to adopt them. It’s unclear whether HHS will fully consider those recommendations. Given that the recent HHS decision was made despite knowing this meeting was imminent, there’s reason to doubt that ACIP’s input will carry the usual weight.
There are many legal and regulatory nuances I won’t unpack here. Still, for this post, the key point is this: ACIP recommendations based on a rigorous review of the evidence will likely differ from FDA and HHS actions.
Clear as Mud?
Now you see why even the experts are confused. Providers can look to their professional societies and other experts to guide their patients. The American Academy of Pediatrics (AAP) and the American College of Obstetricians and Gynecologists (ACOG) have made statements about continuing to recommend COVID-19 vaccines. ACOG’s statement includes the evidence that shows how vaccination in pregnancy protects the infant after birth. However, serious regulatory, insurance, and access questions remain.
Beyond the Confusion
Health policy decisions, like determining who should be recommended to receive COVID-19 vaccines, are complex and high-stakes. These decisions can be life-altering for millions of Americans. Because of the stakes, the U.S. has spent decades building systems to guide these decisions with care, transparency, and diverse expertise.
These systems may be imperfect, but they exist to prevent exactly what we see now: sweeping, unilateral decisions made behind closed doors—actions that fuel confusion and erode public trust.
I spoke with HuffPost about all these developments. In that interview, I shared:
“These recommendations were released without pre-decision transparency, without public input, and before the advisory committees tasked with reviewing the evidence had a chance to weigh in.”
Whether or not a risk-based approach is ultimately the right one, the process matters. Our vaccine advisory systems exist to ensure complex decisions are grounded in science, informed by diverse perspectives, and accountable to the public. Bypassing those structures sets a troubling precedent and risks eroding the trust they were created to uphold.
Equally important, limiting access means limiting choice. “Everyone deserves the freedom to choose effective tools for prevention.”
In another interview, I addressed the shift to shared clinical decision-making and the impact on healthcare providers:
The recently posted immunization schedules recommend “shared clinical decision making” for children – which means talking to your doctor about the potential benefits and risks of the COVID vaccine and making a decision about whether the COVID vaccine is beneficial for your child. Shared clinical decision making about vaccines do happen, but it’s important to note that they can be tricky to implement because you need to have access to a healthcare provider who can have a conversation with you, and we know that doesn’t always happen.
When the approval process and recommendations happen in a way that's outside of the norm, we as healthcare providers don't have clear guidance to help our patients. Having unclear or conflicting guidance about vaccine recommendations can lead to confusion, including providers losing confidence in their recommendations and being unsure of how to help the patient make a decision.
Final Note
Thanks, as always, for being part of this community. I know there’s a lot going on, so I’ll keep tracking the headlines that matter and unpacking what they mean so you don’t have to.
-David
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Community Immunity is a newsletter dedicated to vaccines, policy, and public health, offering clear science and meaningful conversations for health professionals, science communicators, policymakers, and anyone who wants to stay informed. This newsletter is free for everyone, and I want it to be a conversation, not just a broadcast. And if you find this valuable, please help spread the word!
Thank you and hang in there