If It Ain’t Broke…

I’ve always liked the saying, “If it ain’t broke, don’t fix it.” It’s a solid motto—until the espresso maker that’s sputtered for months suddenly refuses to brew. What worked yesterday doesn’t always hold tomorrow, and you’re left with the fix-or-replace dilemma.

This week, the CDC’s Advisory Committee on Immunization Practices (ACIP) faced the opposite dilemma: trying to justify changes to the vaccine schedule—even though no scientific evidence supported them.

And watching the meeting live? Think less polished government meeting, more rookie football.

Rookies & Rockstars
Here’s the lineup: of the 12 ACIP members, 11 are brand new. One lone veteran served on ACIP years ago. Health and Human Services (HHS) Secretary Robert F. Kennedy Jr. dismissed the entire 14-member Committee and handpicked replacements—something that has never happened before.

It showed. There were clumsy moments, awkward pauses, and fumbles over Robert’s Rules of Order. The CDC scientists, by contrast, were rock solid—crisp presentations, precise answers, and calm responses to some surprisingly naïve questions.

The Big Questions
The Committee weighed possible changes to recommendations for three vaccines:
• Hepatitis B – birth dose
• MMRV – measles, mumps, rubella, varicella (chickenpox)
• COVID-19

On the surface, it looked like routine business. But none of the proposals were backed by new scientific evidence. Traditionally, the CDC only revises vaccine recommendations when fresh data warrants it.

This time, the debate was driven less by science and public health, and more by personal beliefs, concerns about side effects, and anecdotal stories.

Been There, Done That
Today babies receive their first hepatitis B shot at birth, no matter the mother’s test results. Committee members suggested delaying that dose until one month if the mother tests negative.

It might sound reasonable—until you look at history. In the 1980s, the vaccine was limited to “high-risk” groups (infants of infected mothers, sex workers, IV drug users). That strategy failed: one-third of infections occurred outside those groups, and the virus kept spreading.

Here’s why: hepatitis B isn’t only passed from mother to child. The virus can survive up to a week on surfaces, and even microscopic traces of blood on a desk or playground can infect. According to the CDC, about 2.4 million Americans are estimated to carry the virus, half without knowing it.

For infants, the risk is especially high: 90% of those infected develop chronic illness, and about 25% die prematurely from liver disease or cancer. The universal birth-dose recommendation in 1991 is a public health success – infections in children and teens were reduced by 99%.

Tell Me Why
As the Day 1 meeting drew to a close, and and the vote loomed on delaying the hepatitis B birth dose, the obvious question was finally asked: why change the current recommendation?

One Committee member, a father of six, voiced frustration that he hadn’t been informed his children received the shot at birth and pressed for stronger informed consent. Another said the proposal stemmed from declining vaccine trust after COVID and concerns about newborn interventions, like vaccines.

The Committee voted unanimously to reaffirm the universal screening of pregnant women—already standard practice. Next up was an ambiguously worded recommendation to delay the first hepatitis B dose for babies of test negative mothers. With time running out, the Committee punted the vote to Day 2, where members agreed to table the proposed recommendation, with no timeline for revisiting.

Clean-up on Aisle 4
The MMRV vaccine—a combination shot for measles, mumps, rubella, and chickenpox—was also reviewed. Most kids get separate MMR and chickenpox shots, but parents can opt for the four-in-one. The side effect risk—febrile seizures, caused by high fever—has been known for nearly two decades. While frightening, these seizures are rare, temporary, and do not cause long-term harm. Still, the Committee voted to no longer recommend the MMRV for kids under 4, thus eliminating Medicaid, CHIP, and ACA coverage of it.

Confusion followed on a proposal to also change the MMRV recommendation for the federally funded Vaccines for Children (VFC) program, which provides shots for about half of U.S. kids. The Committee voted not to change the VFC schedule, which meant the vaccine would remain recommended (and covered) for children under 4.

By the next morning, ACIP realized their MMRV decision for VFC conflicted with recommendations for Medicaid, CHIP, and ACA plans. They voted again, this time excluding the vaccine for coverage under VFC.

Bottom line: parents and doctors just lost a vaccine option they previously had—with no new science to justify it.

COVID-19 Tie Breaker
Day 2 and the COVID-19 vaccine was on the table. The Committee opted not to recommend the vaccine. Instead they recommended “shared decision-making,” leaving the choice to patients and providers (physicians, nurses, pharmacists) for anyone over 65, and for those 6 months to 64 with underlying health conditions.

The Committee’s other proposal—to require a prescription for the vaccine—nearly passed. Supporters argued it would guarantee thoughtful discussion of patients with their providers of the benefits and risks of the vaccine. Opponents said it would create unnecessary barriers, especially since pharmacists in many states can’t write prescriptions.

The vote tied, leaving the Chair to break it. The result: no prescription requirement. In short, not much changed—except the meeting amplified misinformation more than evidence.

The Takeaway
After two days, nothing was fixed—because nothing was broken.
The vaccine schedule that has protected millions remains intact. But the meeting highlighted the risks of making decisions without solid science.

As poet Nikky Finney reminds us:
“You are not responsible for breaking the glass but you are responsible for walking away as if you were not involved, as if you were not there, as if you did not have the power or the courage to do something to try and make it right.”

For now, the glass is intact—but it may not stay that way.

Happy reading,
Suzanne Daniels

Enjoy the weekend!

Best,
Suzanne
Suzanne Daniels, Ph.D.
AEPC President
P.O. Box 1416
Birmingham, MI 48012
Office: (248) 792-2187
Email: [email protected]