A major threat to US vaccine recommendations has emerged, with the recent layoffs of staff supporting the Advisory Committee on Immunization Practices (ACIP). This committee plays a crucial role in shaping vaccine policies, but it's now facing significant challenges.
The ACIP, which normally relies on dedicated CDC staff and outside experts, has seen its support system crumble. Most of its working groups, responsible for analyzing data and setting agendas, have been inactive for months. And with the recent layoffs, the situation has only worsened.
But here's where it gets controversial... The US health secretary, Robert F Kennedy Jr., made headlines by replacing all independent vaccine advisers with his own picks, including vocal anti-vaccine activists. This move has raised concerns about the committee's ability to function effectively.
The CDC staff who were laid off provided essential logistical support and subject-matter expertise. They ensured the committee followed rules and regulations. Now, with their absence, the committee's operations are at risk of further disruption.
"CDC scientists are being held hostage," says Demetre Daskalakis, former director of the National Center for Immunization and Respiratory Diseases. He adds that the entire department supporting the ACIP is now "gone."
Kevin Ault, an obstetrician-gynecologist, describes the impact on recent meetings: "You've kind of seen that fall apart." Presentations were missing, Zoom links and microphones weren't working, and there was a lack of communication about votes.
And this is the part most people miss... The effects of these terminations and shakeups extend beyond the agency. Working groups often include subject experts, local health officials, and medical group representatives. These groups have been largely inactive for at least six months, impacting the development and recommendation of new vaccines.
Ault, a former ACIP member, highlights the fragmented and haphazard nature of the current situation. Flu recommendations were published without a working group meeting, and some medical groups were disinvited from providing input.
The only apparent exception is the new Covid vaccine group, but even its processes are unclear. Daskalakis notes that working group members have been "sidelined," with their data being "criticized and ignored."
The future of vaccine recommendations in the US is uncertain. A vaccine schedule should be published by January 1, but the government shutdown has temporarily closed the usual publication channel. The October meeting, where this schedule would've been discussed, has been rescheduled indefinitely.
"All vaccines for children and, to some extent, adults are at risk," Ault warns. He adds that promising new vaccines in late-stage clinical trials may never be recommended.
Daskalakis describes the situation as losing the "operating system" for the advisory committee. The RIFs, which affected other departments like human resources and the ethics office, could further limit the committee's future actions, according to Debra Houry, former chief medical officer for the CDC.
The recent changes to the ACIP have sparked concerns about the future of vaccine recommendations in the US. With key staff gone and the committee's operations disrupted, the path forward is indeed murky. What do you think? Should the government prioritize stabilizing the ACIP, or is there a better way to ensure vaccine recommendations remain effective and unbiased?
