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The committee that sets national vaccine recommendations voted to change policies surrounding two major childhood inoculations after gathering last week for two days of contentious and chaotic meetings.

The 12 members, who were recently handpicked by controversial Health and Human Services Secretary Robert F. Kennedy Jr., also debated overturning decades of established practice around hepatitis B shots for newborns, though they ultimately tabled that vote.

The other two shots in play were the measles, mumps, rubella and varicella (chickenpox) combination vaccine, also known as MMRV, and this year鈥檚 COVID 19 booster. 

By the end of the week, the Advisory Committee on Immunization Practices, also known as ACIP, voted to no longer recommend the MMRV combination vaccine for kids under 4 years old, rendering it largely inaccessible for that age group. 

The committee also voted to shift the COVID 19 booster recommendation to 鈥渟hared clinical decision making鈥� for all people over 6 months old 鈥� regardless of age or risk level 鈥� meaning that before getting the shot, individuals will need to talk through the pros and cons with a health care provider, which includes pharmacists. 

Through this departure, the committee largely preserved access and insurance coverage, while also raising doubts about the effectiveness and safety of the vaccine, at times citing debunked theories.

鈥淭here is just widespread confusion about, 鈥榃hat should I do as a parent? Who should I listen to?鈥欌�� said Northe Saunders, executive director of the pro-vaccine advocacy organization , formerly called SAFE Communities Coalition. 

鈥淎merican parents and American providers don’t actually know what the best recommendations are anymore,鈥� he added, 鈥渁nd so that is going to lead to more hesitancy, because there’s uncertainty about what the right thing to do is, and that’s going to lead to declining immunization rates.鈥�

Before the ACIP meeting, MMRV and hepatitis B vaccine recommendations were based on decades of established practices supported by science, which experts described as 鈥渟ettled,鈥� so it was unclear why they were being relitigated, according to numerous medical professionals, including those who spoke during the meetings as well as those interviewed by The 74.

The point of these conversations is, 鈥渢o raise doubt, to confuse people,鈥� said Paul Offit, the director of the and an attending physician in the Division of Infectious Diseases at Children鈥檚 Hospital of Philadelphia. Offit was instrumental in the creation of the rotavirus vaccine and previously served as an ACIP member. 

鈥淭he degree to which the public is confused about vaccines is the degree to which they will be less likely to get them,鈥� he said, 鈥渁nd that is RFK Jr’s goal: to make vaccines less available, less affordable and more feared.鈥�

The meetings themselves appeared to be marked by moments of pronounced confusion for the new committee members, some of whom asked for clarification around what they were voting on multiple times.

At least some of this was likely due to their unusual level of inexperience, which committee Chair Martin Kulldorff even noted as he opened day two on Friday.

鈥淲e are rookies,” Kulldorff “With one exception, this was either our first ACIP meeting or our second.”

Typically, committee members are highly qualified medical professionals who are vetted for months to years before serving. In an unprecedented upheaval earlier in June, Kennedy Jr. fired all 17 existing advisory members via a Wall Street Journal 鈥� after promising he would leave the committee鈥檚 recommendations intact. 

Almost immediately he brought on eight new members, a number of whom have espoused anti-vaccine rhetoric and other scientific misinformation. One of them eventually stepped down and Kennedy then added an additional five members leading up to last week鈥檚 sessions.

Measles, mumps, rubella and varicella

The MMR vaccine was in the United States in 1971, followed by the MMRV vaccine in 2005. Two doses of the combined shot were preferred until 2008, when monitoring studies showed an increased risk of febrile seizures 鈥� convulsions in a young child caused by a fever 鈥� following the first dose. 

While these seizures are short-lived, resolve themselves and are not associated with any long-term negative outcomes, 鈥渢hey鈥檙e hard to watch,鈥� said Offit.

So by 2009, the CDC released updated recommendations, in place up until Thursday鈥檚 vote, which advocate for separating MMR and varicella for the first dose at age 12-47 months and administrating the combined shot for the second dose at age 4-6 years old. These vaccines are among those required for school entry in all 50 states, though numerous states have recently introduced legislation to loosen mandates, and exemptions are on the rise.

The vast majority of parents (85%) opted to follow that recommendation for separating the shots, with 15% still choosing the combination vaccine for the first dose, often to avoid multiple jabs of an infant.

The committee鈥檚 recent update to the recommendations will mean that choice no longer exists.

While this change itself is 鈥渘ot a huge deal,鈥� Offit said, the arguments brought up by committee members were 鈥渋ntellectually disingenuous鈥� and will only continue to 鈥渞aise doubt.鈥�

Stacy Buchanan is a pediatric nurse practitioner and a clinical professor who is the National Association of Pediatric Nurse Practitioners鈥� liaison to ACIP

鈥淚 really feel like this was brought up to just further confuse caregivers that are already questioning whether or not they want to have their child vaccinated,鈥� said Buchanan. 鈥淎nd in a time where we’re seeing unprecedented numbers of measles in communities, I think that we need to be really clear that the MMR vaccine 鈥� whether you’re getting the combined or two separate injections 鈥� is really key and needs to be administered routinely based on the schedule.鈥�

In past years, the liaisons like Buchanan, who have on-the-ground clinical experience, would weigh in during the committee鈥檚 working group meetings to help evaluate the evidence. That precedent was unexpectedly overturned in late July when the liaisons received an email accusing them of being and no longer permitted to serve. Now they can only be heard during the public comment portion of the meetings.

In a statement released Thursday, the American Academy of Pediatrics wrote, 鈥淭oday鈥檚 meeting of the federal Advisory Committee on Immunization Practices (ACIP) promoted false claims and misguided information about vaccines as part of an unprecedented effort to limit access to routine childhood immunizations and sow fear and mistrust in vaccines. Following today鈥檚 meeting, instead of emerging with clear guidance about vaccines that we know protect against serious illnesses, families are left with confusion, chaos and false information.鈥�

The AAP also emphasized that they had released their own , which includes unchanged MMRV vaccination recommendations.

Committee members elected for the combination shot for those under 4 to remain covered by Vaccines for Children, which provides vaccines to millions of kids who otherwise wouldn鈥檛 be able to afford them, despite their recommendation against its use. Some members apparently misunderstood what they had voted on Thursday and reversed their stance the next morning. 

COVID 19 booster

On Friday, the committee voted on four measures surrounding the COVID 19 booster shot. Three passed, and the fourth, which was the most controversial and would have recommended required prescriptions for anyone seeking to get the shot, ended in a tie vote that ultimately failed.

During his presentation, Retsef Levi, put in charge of the working group on COVID, raised a number of concerns around mRNA vaccines that have been widely disputed, including the assertion that they could change the way the body reacts to its own genetic material. Levi is a professor of operations management at MIT鈥檚 Sloan School of Management and has no formal medical training.

The three provisions that did pass will mean that while the vaccine is not actively recommended for anyone 鈥� including those at high risk of infection 鈥� those over the age of 6 months can access it as long as they make the decision in conjunction with a health care provider.

Richard Hughes, a George Washington University law professor and leading vaccine law expert, said the committee appears to be using the practice known as 鈥渟hared clinical decision making,鈥� because it 鈥済ets at that medical freedom rhetoric 鈥� and provides an option other than 鈥榥o recommendation鈥� 鈥� but is not a good option.鈥�

While this sort of policy sounds like it鈥檚 creating greater choice, ultimately evidence shows it leads to struggles for health care providers who haven鈥檛 been given clear risk factors, Hughes said. This can be cumbersome, time consuming and lead to patient distrust.

鈥淲hen you know that it鈥檚 an automatic 鈥榶ou should get it鈥� that鈥檚 different than 鈥業 don鈥檛 know, it鈥檚 kind of murky,’鈥� he added.

The new policy is particularly confusing, said Offit, since last month the Food and Drug Administration only licensed the boosters for those . 

鈥淭he good news is, anybody can use it,鈥� Offit said, 鈥渆ven though, according to the FDA, they’d be using it off label. But we don’t recommend it for anybody. Basically, that’s what they’re saying.鈥�

He described this as a 鈥渂ad choice鈥� which will lead to fewer people being vaccinated and fragmented state-by-state policies.

Earlier this month, the governors of Washington, California and Oregon announced they鈥檇 be forming to establish their own vaccine recommendations, which Hawaii quickly joined. A few weeks later, seven northeastern states, including New York and Pennsylvania, formed with a similar goal.

Hepatitis B

The hepatitis B vaccine was first recommended by ACIP in Before that point, an estimated 200,000 to 300,000 people, including about 20,000 children, were infected with the highly contagious virus each year. 

This was particularly dangerous for infants who have a 90% chance of developing liver cancer or chronic liver disease, if they contract the virus. For 4- and 5-year-olds, that chance remains high at 30-40%.

At one point, the vaccine was only recommended for infants whose mothers tested positive for the virus, since it can be transmitted during birth, but for a number of reasons 鈥� including inaccurate test results 鈥� this was found to be ineffective. So by 1991, ACIP鈥檚 recommendation was expanded to include universal birth doses. Since then, infant infections have dropped by 95%.

According to Offit, the birth dose 鈥渉as always been a target of anti-vaccine activists,鈥� since the hepatitis B virus can be transmitted sexually. But it can also be transmitted in many other ways, including through surfaces. 

On Thursday, ACIP members were meant to vote on an updated recommendation which would have delayed the initial dose until an infant is one month, a move that would likely lead to a serious reduction in uptake, according to doctors.

Ultimately, after hours of arguments, which included research Offit called 鈥渂ogus,鈥� the committee ran out of time to vote on the measure Thursday. Friday morning they chose to table it indefinitely. 

Buchanan, the nurse practitioner, expressed concern that the safety of the well-established vaccine was even being reargued in the first place: 鈥淭he 鈥榳hy鈥� was never there, and that’s so important, because we should not be bringing things to a formal ACIP committee vote without having a science-based rationale for bringing the question forward.鈥�

While Hughes was relieved the vote was punted, Offit was more pessimistic, expressing fears that the committee will eventually try to push the first dose even later than one month.

鈥淎nd that would be a tragic decision,鈥� he said. 鈥淭hat would mean that there will be children in this country who will get hepatitis B in the first year of life, or in childhood 鈥� which will limit their life for no reason.鈥�

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