Crunch time arrives for RFK Jr.'s vaccine advisers

• But Kennedy's summertime purge of the committee — and the lack of a full-time political leader at the agency — has many in the scientific community convinced that the new appointees will rubber-stamp more limits on who can get routine shots.

What they're saying: "ACIP has quite literally been the north star of America's approach to vaccination for decades," Jason Schwartz, a vaccine policy expert and associate professor at the Yale School of Public Health, told Axios.

• "That's why it was so often the focus of criticism by critics of vaccines, and I think that's why we're seeing such attention on the part of the administration."

Friction point: The Democratic governors of Oregon, Washington, California and Hawai'i released a set of immunization guidelines for their own states on Wednesday that, among other things, appear to eliminate the need for a prescription to get the 2025-2026 COVID-19 booster.

• And the health insurance trade group AHIP said its members would continue to cover immunizations the advisory committee recommended as of Sept. 1, including updated COVID-19 and flu shots, at no cost to patients through the end of next year.

Inside the room: The ACIP agenda calls for discussions over two days on the hepatitis B vaccine, the MMRV vaccine and COVID boosters, as well as the safety review of COVID vaccines already delivered.

• The Washington Post reported Trump administration officials will present data from a federal database of adverse events and side effects linking COVID vaccines to the deaths of 25 children, even though the database isn't designed to show causality.
• Other topics on the agenda include reports of seizures following MMRV vaccine and doses of hepatitis B vaccine given at birth.
• ACIP will depart from past practice and no longer solicit input from liaisons from the American Medical Association and other health care organizations, citing conflicts of interest.

A Health and Human Services spokesperson said Kennedy is "restoring public trust by reconstituting ACIP with highly credentialed doctors, scientists and public health experts committed to evidence-based medicine, gold standard science and common sense."

• The old ACIP "had become little more than a rubber stamp for any vaccine," and the new panel "will demand definitive safety and efficacy data for any new vaccine recommendations," the spokesperson added.

Zoom in: It's not clear there is any new data for the committee to consider to justify changes to the delivery of vaccines.

• The delivery of hepatitis B shots to newborns helped put an end to 20,000 infections a year for infants, whose chances of developing chronic disease is 90%, said Anthony Fiore, a former CDC researcher who focused on the delivery of that vaccine and presented data to ACIP in the past.
• Eliminating that shot or delaying when it is recommended would likely lead to drastic drops in the number of kids being immunized before exposure, resulting in an uptick in infections among teens in just over a decade, he said.
• Meanwhile, about three decades down the line, cases of liver cancer and cirrhosis will rise among those who were silent carriers of chronic hepatitis B infections, he said.

Between the lines: MMRV has been linked to a small but meaningful increase in seizures among children ages 12 months to 47 months. Many doctors already opt to separately administer the measles-mumps-rubella vaccine and the varicella vaccine for that reason, said Katrina Kretsinger, an infectious disease doctor who formerly worked at the CDC.

• They may still choose to use the MMRV shot in an older child who is at lower risk. But she said it's puzzling that this shot is coming up for discussion now, with little information released about what's to be discussed.
• "I don't know what new data are going to be presented, if any at all," Kretsinger said.

Friday's agenda will be solely devoted to COVID shots. That could include debate over the appropriateness of using the federal Vaccine Adverse Event Reporting System, or VAERS, to flag safety concerns and risk of death.

• VAERS is supposed to gather reports of adverse reactions from a wide variety of sources but isn't designed to assign a cause.
• "It's like when your smoke detectors go off in the middle of the night, do you immediately call 911 and evacuate the house or do you look at what's causing it?" Fiore said.
• One concern is any new restrictions could limit access to shots for those who depend on the Vaccines for Children Program, which is designed to provide free shots to children whose parents and guardians can't otherwise afford them, said Philip Huang, director of Dallas County Health and Human Services.

Between the lines: Researchers doubt autism will be mentioned. But the debunked theory that vaccines are linked to the condition, and Kennedy's forthcoming report on causes of autism, will be part of the subtext.

• "Autism will very much be the elephant in the room when it comes to any of these discussions about vaccine safety or the future the vaccine schedule, even if it isn't an explicit topic voiced around the table," Schwartz said.

The bottom line: The CDC's vaccine advisory panel has long been a bulwark of evidence-driven policy.

• But Kennedy's changes could weaken public trust, reshape childhood immunization practices and reopen the door to diseases the U.S. thought it had under control.