“High level” discussions are underway to establish an independent US vaccine committee following the dismissal of 17 members of the Centers for Disease Control and Prevention’s advisory committee on immunisation practices (ACIP) by US health secretary Robert F Kennedy Jr.1
In an interview with The BMJ, Noel Brewer, a public health professor at the University of North Carolina and one of the recently ousted members of the CDC advisory committee, said he had heard “more than rumours” that an independent vaccine advisory group separate to ACIP was being “discussed by people at a high level.” He said that he was not part of those discussions.
“The abrupt changes have dramatically undermined trust in ACIP recommendations among healthcare providers,” he said. “If the actions of the new committee do not build credibility quickly among the provider community, then some alternative is going to be needed.”
Brewer said that the question now is whether vaccine policy should be set by a body funded by the US government or handled independently by the professional medical organisations that administer vaccines to patients.
“For children, 80% of vaccines are delivered by paediatricians,” he said. “So very likely that would mean guidance from the American Academy of Pediatrics and the American Academy of Family Physicians. But we should also include physician associates, nurse practitioners, nursing organisations, and educational groups like the Children’s Hospital of Philadelphia.”
“Healthcare providers need stability,” Brewer added. “They need to be able to focus their limited time on taking care of patients.”
Eight new ACIP members have been announced so far.2 “They are the new ACIP,” Brewer said. “We’re going to have to hope that they can do a fantastic job. All of them are critical thinkers. And some of them think in ways that are non-traditional.”
Brewer said the mass dismissal came as a shock to him—and warned that consequences for patients may be severe. “Half of childhood vaccines in America are provided through the vaccines for children programme, paid for by the US government. For private insurance, the Affordable Care Act requires first dollar coverage for vaccines approved by ACIP.”
“If ACIP doesn’t recommend a vaccine, insurance coverage could be denied. That could be one of the levers for increasing health disparities,” he said. It could be that only those with private health insurance are able to access certain vaccinations, Brewer explained.
“Fired in an op-ed”
Brewer revealed that he had no idea his dismissal was coming before reading about it in the newspapers on 9 June. “I was fired in an editorial in the Wall Street Journal,” he said, referring to an article written by Kennedy that announced the action before any official communication, even to ACIP members.
“At 4 pm the article was published and at 4 02 pm I had journalists sending me copies of it. That’s how I heard I was fired and shared it with colleagues,” he told The BMJ. He said he did not receive an official termination notice from the government until 5 48 pm.
“It’s the first time I’ve been fired in an op-ed,” he added, pointing out that the CDC is not currently able to handle all its own communication, given the mass layoffs at federal agencies under the Trump administration. The CDC has also been without a permanent director since January, with the acting director position needing to be filled twice in the time since.
Brewer said the new committee’s abrupt formation, announced by Kennedy just days later, risks damaging trust among healthcare providers and clinicians. In normal circumstances it takes over a year to confirm and bring new members—who are meant to join on a rolling basis to preserve institutional memory—up to speed. Brewer said it had taken him 18 months from first application to being in post.
Uncertainty and instability
“It takes time to be able to understand the complex data that CDC staff present,” he said. “ACIP follows an ‘evidence to recommendation’ framework. It’s a dizzying amount of information. I remember one of the recent presentations on covid-19 vaccines had 140 slides. Each one was dense.”
Yet the new ACIP members seem set to start almost immediately, with an existing meeting on 25-27 June already in the diary to discuss new recommendations for covid-19, influenza, and human papillomavirus vaccines.
“It’s unclear how the new members will be brought up to speed on the work that’s been done to date and whether they will just start again,” Brewer said.
Brewer was three years into his four year term when he was removed and was puzzled as to why some members had been removed so swiftly when their terms were going to expire at the end of June.
Asked about conflicts of interest—one of the reasons Kennedy has given for the sweeping changes—Brewer said, “ACIP has one of the most rigorous conflicts of interest policies of any federal advisory committee and indeed any organisation I’ve had any relationship with.”
He expressed concern over the politicisation of vaccine guidance, and the long term impact on public health. “We are in a bad place if ACIP becomes a blue thing under a Democratic administration and a red thing under a Republican one. We can’t keep toggling back and forth over the next 50 years. It will create instability that will make it harder for insurers to know what to pay for, for healthcare providers to deliver vaccines effectively, and for the public to know what to trust.”
