Unpacking the ACIP Overhaul: Chaos and Controversy

Medscape

11-07-2025

This transcript has been edited for clarity.
This edition of Medicine Matters underscores the chaos and controversy at the June 2025 Advisory Committee on Immunization Practices (ACIP) meeting.
What Is ACIP and Why Are ACIP Recommendations So Important?
ACIP was established in 1964, and its charge was to make vaccine recommendations for the entire country. For years, ACIP's collaborative, transparent, and evidence-based process has been trusted by clinicians and helped protect Americans from vaccine-preventable diseases.
ACIP recommendations are directly tied to insurance coverage. ACIP-recommended vaccines on the child and adult immunization schedules have to be covered by Affordable Care Act (ACA)-compliant insurance plans. ACIP also makes recommendations about which vaccines should be included in the Vaccines for Children (VFC) program. VFC ensures every child in America has access to vaccines — even if their parents can't afford them. This program provides vaccines to 50% of children in this country.
I've been a liaison to ACIP for nearly two decades. In those 20 years, during both Republican and Democratic administrations, I've observed ACIP to be the crown jewel of our public health system, preventing hundreds of thousands of hospitalizations and deaths and untold suffering. ACIP has also been a beacon of trust for physicians and the public when it comes to vaccines.
ACIP Overhaul Leads to Controversy at the June Meeting
That crown jewel was blown apart in early June when the new HHS Secretary, Robert F. Kennedy, Jr, removed all 17 ACIP members, claiming — but not explaining — supposed conflicts of interest. Many of Kennedy's eight handpicked replacements have gone on record with preconceived bias against vaccines. One appointee withdrew his name due to financial conflict-of-interest concerns.
For a few days, it seemed "touch-and-go" as to whether the meeting would even happen. Senator Bill Cassidy, the physician who chairs the Senate HELP Committee, was so concerned about the qualifications of this new panel that he wanted the meeting to be delayed.
The draft agenda for June's ACIP meeting, first posted mid-June, was significant in itself for what it did not include. A highly anticipated discussion and vote on HPV vaccines was entirely omitted. The agenda also lacked a vote for COVID vaccines.
On Tuesday, May 27, HHS Secretary Kennedy made an HHS directive and unilaterally removed COVID vaccines from the immunization schedule for healthy children and for pregnant women. He made this announcement on social media. No new evidence was cited to support this decision. Absent from this announcement was any representative from the CDC or ACIP.
A new addition to the ACIP agenda — a thimerosal presentation by Lyn Redwood— was probably the most controversial. Her presentation slides that were originally posted on the ACIP website initially cited a study that didn't exist and did not accurately represent conclusions of other articles that do exist.
A CDC review of the evidence debunked thimerosal myths and refuted Redwood's comments. This CDC review (initially put up on the ACIP website and then abruptly taken down) clarified that all childhood vaccines licensed and recommended in the US have been thimerosal-free since 2001, with the exception of some multidose formulations of flu vaccines. It also explained the evidence does not support an association between thimerosal-containing vaccines and autism spectrum disorder or other neurodevelopmental disorders.
When it came time to vote, the new panel reaffirmed routine annual flu vaccination for everyone 6 months or older. But when additional votes involved thimerosal, all but one member ignored the true scientific evidence. Six of the seven members of the panel voted to remove thimerosal from flu shots for children, pregnant women, and adults. The only one who followed the evidence and voted against this decision was the sole pediatrician on the panel, Dr Cody Meissner. Dr Meissner previously served on the ACIP and explained, "The risk from influenza is so much greater than the nonexistent, as far as we know, risk from thimerosal."
Concerning Comments From ACIP's New Chair
The new chair of the ACIP, Martin Kulldorff, PhD, called for ' a review of long-approved vaccines.' He said ACIP will be taking a look at the cumulative effect of the recommended vaccine schedules, including interaction effects between different vaccines, the total number of vaccines, cumulative amounts of vaccine ingredients, and the relative timing of different vaccines. The current child and adult schedules are evidence-based and have been in place for long periods of time. This type of review could totally upend the child and adult immunization schedules as we know them.
Kulldorff also explained that ACIP will be taking a new look at use of the MMR and varicella vaccine for young children. Further, he announced that a new vaccine work group may look at the need for the universally recommended hepatitis B vaccine dose on the day of birth — a cornerstone of hepatitis B prevention for the entire population. The American Academy of Pediatrics (AAP) has already pushed back on social media, explaining that passing the virus from parent to baby at birth can be deadly.
Medical Organizations Speak Out and Push Back
Meanwhile, organized medicine has gone on the offensive. The AAP showed its disapproval by boycotting the meeting. The American Medical Association (AMA) released a statement that this removal of ACIP's 17 qualified members 'undermines that trust and upends a transparent process that has saved countless lives.' The AMA, along with 78 other medical organizations, also issued an open letter to the public, backing vaccination as the best way to protect against respiratory viruses, including flu, COVID, and RSV, and their potentially serious complications. These organizations called on insurers, hospitals, and public health agencies to ensure these life-saving vaccines remain available to patients without cost-sharing.
Many physicians and other clinicians are looking for alternatives for vaccination guidance now that it seems the CDC can no longer be their "North Star." Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota, is already launching the Vaccine Integrity Project.
An Unclear Future for Vaccine Policy and Public Health
This is the tragic bottom line: ACIP was put on life support when all 17 of the remarkable physicians, scientists, and vaccine experts were fired for clearly political reasons. This first ACIP meeting since that purge confirmed our worst fears. It gave platform and voice to an unscientific, debunked presentation on the vaccine preservative thimerosal, given by someone who was clearly unqualified and uncredentialed to even address this issue. ACIP is supposed to address vaccine policy that can bring health and happiness — not death and illness — to our country.
America's physicians try to work collaboratively with everyone at these public health agencies to advance the nation's health. But physicians must also stand up for our patients. We must push back on misinformation, medical foolishness, and quackery. Unfortunately, that is the only way to describe that thimerosal presentation and — more importantly — the 6-1 vote that adopted the debunked thimerosal presentation as ACIP policy.
Misinformation is designed to stoke mistrust in vaccines. Mistrust reduces vaccine uptake, and reduced vaccine uptake kills and sickens our patients. We wouldn't be in the midst of a measles outbreak but for vaccine hesitancy.
If this is what we can expect out of the new ACIP, physicians need to get ready for more suffering and death — because that is surely what is coming.