The ascension of Robert F. Kennedy Jr. to Health and Human Services secretary gives the longtime activist against vaccines broad control over federal health policy, including the government's stance on vaccines.
Despite Kennedy's assurances during confirmation hearings that he is not "anti-vaccine," his questioning of settled science on the overall safety of vaccines and his unwillingness to declare vaccines safe and effective in those hearings worries many doctors and people in public health.
One area to watch is an independent advisory committee to the Centers for Disease Control and Prevention, part of HHS, that plays a key role in setting vaccine policy. While serving a critical role, the Advisory Committee on Immunization Practices, or ACIP, lacks guardrails against interference, experts say.
An obscure committee enters the spotlight
Sen. Bill Cassidy, a physician and Republican representing Louisiana, cast a key vote to advance Kennedy's nomination to the full Senate. In a floor speech after the committee vote, Cassidy said he was able to vote for Kennedy after securing assurances that he would "maintain the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices recommendations without changes."
But soon after Kennedy was sworn in Thursday, he told Fox News that he didn't trust the experts on such advisory committees. "In the past, these people — almost all of them — have severe, severe conflicts of interest, and that's not good for our country," he said.
Why the focus on a committee that has largely operated outside the public eye?
Because the panel is instrumental to CDC's vaccine policymaking. The outside experts make recommendations for the agency's vaccine schedule for children and adults, and help determine which vaccines get covered by health insurance and the Vaccines for Children Program.
Former committee members say there are many ways the Trump administration could influence the group's work. "Unfortunately, the way ACIP and other federal advisory committees are structured, there's an opportunity for political interference from above," says Dr. John Modlin, professor emeritus of pediatrics at the Dartmouth Geisel School of Medicine, who chaired the vaccine committee from 1997-2003.
The committee, with up to 19 voting members per its current charter, plays at least three key roles, says Dorit Reiss, a vaccine policy researcher and professor at University of California College of the Law, San Francisco.
First, the committee makes recommendations on which vaccines should be included in the vaccine schedule. They are generally adopted by the CDC director, along with professional societies such as the American Academy of Pediatricians and the American Academy of Family Physicians. "Those recommendations are what physicians use to tell people which vaccines they should get," Reiss says.
Secondly, the committee has the legal power to determine which vaccines are covered by insurance and other programs that improve affordability and accessibility. Since the 1990's, childhood vaccines recommended by the group must be offered for free through the Vaccines for Children program, which serves uninsured or underinsured youth, and for which about half of U.S. youth are eligible. Separately, insurance companies must cover vaccines on the schedule under the Affordable Care Act, Reiss says.
Thirdly, the committee serves as a vaccine watchdog, regularly reviewing the safety and effectiveness of existing vaccines.
Here are a few ways Trump administration officials could change how the group works.
Change the roster
The committee's voting members tend to be experts in vaccines, immunology, pediatrics and other relevant medical fields, with advanced medical degrees and board certification. Members apply to serve in staggered, four-year terms. They are vetted by the ACIP Steering Committee and chosen by the secretary of Health and Human Services, according to the CDC.
According to reporting from STAT News, Biden administration officials approved a pipeline of panel members that would keep it filled through 2026.
But HHS Secretary Kennedy has veto power over who sits on the committee. "There would be nothing stopping RFK Jr. from firing the entire board and replacing them all with vaccine skeptics," Sen. Patty Murray, a Democrat from Washington, said in a floor speech before the final confirmation vote. "He has said many many times and in many ways he thinks CDC is corrupt and bought by pharma, as usual by the way, without any evidence."
Reiss, at UC Law, agrees with the assessment. "Generally speaking, removal of public officials in the United States is at will unless there are express provisions protecting them, and there's none for ACIP. The secretary could remove them at will and appoint others," she says.
While Kennedy claimed in his confirmation hearings — and again, in a Fox News interview after being sworn in — that ACIP members are rife with conflicts of interest, those who have overseen or participated on the committee in the past say this is untrue.
"It's a falsehood that can undermine trust in vaccines and endanger our children," Dr. Tom Frieden, a former CDC director and president of the nonprofit Resolve to Save Lives, said in a press call Febuary 4. Committee members are vetted for conflicts of interest and close ties to vaccine makers. Once they become members, they are required to file disclosure reports yearly and must recuse themselves from discussions and decisions for topics where they have actual or perceived conflicts of interest.
Set the science agenda
As an advisory committee to the CDC, the panel relies on support from CDC employees.
A CDC official serves as the group's executive secretary, and its public meetings often include presentations prepared and delivered by CDC staff. For instance, the agenda for an upcoming meeting in late February has CDC employees presenting on every topic under consideration.
Typically, these presentations include data collected and analyzed by the CDC, and shares assessments of the benefits, risks and costs of vaccine products, graded to reflect the quality of the science they're basing it on.
But early moves by the new Trump administration to curtail public communications from health agencies, and alter content on the CDC's website to comply with executive orders on gender identity and DEI, have raised the prospect that future public presentations may be filtered through the lens of political appointees.
"I think this is a legitimate concern," says Modlin, the former ACIP chair.
"If there was a statute requiring that some of the information be, for example, scientifically objective, it might be different, but there isn't such a statute. The administration can change the information provided [if it wants to]," Reiss says.
Besides public meetings, ACIP members attend closed, monthly work group meetings focused on topics such as vaccines for Mpox, COVID-19 and HPV alongside staff from the CDC and other agencies and subject matter experts. "If you control the CDC staff, you could control the presentation and the data given to the committees, so that's another area of access," Reiss says.
And since these work groups are "guided by CDC and HHS priorities, and by the perceived need for expert advice to inform development of immunization policy," according to ACIP's standard operating procedures, heads of CDC and HHS have leeway to add different perspectives to existing work groups, or create new ones focused on their interests.
Reject the advisers' recommendations
There are limits to ACIP's authority. The immunization committee makes recommendations to CDC and if the CDC director approves them, as is usually the case, they become official CDC policy. "But the CDC director doesn't need necessarily to follow that advice," says Dr. Paul Offit, director of the Vaccine Education Center at the Children's Hospital of Pennsylvania, who served on ACIP from 1998-2003. The director also has the power to reject or amend them.
Trump's pick to lead the CDC, Dr. Dave Weldon, is a family physician and former Republican congressman from Florida, who has previously pushed disproven claims linking vaccines with autism.
Offit says there's a recent example of the director tweaking the policy recommendations. Dr. Rochelle Walensky, who served as CDC head early in the Biden administration, overruled the advisory committee in 2021 when she recommended COVID-19 booster shots to workers whose occupations put them at higher risk of COVID exposure, after the committee had voted against it. "Dr. Walensky went beyond what the ACIP voting members said, and did something she felt was important to do on her own. So ACIP is only so powerful," Offit says.
Besides overturning recommendations directly, the CDC director or other members of ACIP could also curb vaccine access by moving more vaccines from routine vaccinations people "should" get to those they "may" get if they and their doctors decide it's a good idea. This categorization, known as "shared clinical decision-making," softens a recommendation in the public eye and opens the possibility for some insurers not to cover the costs..
Disband the committee altogether
Could the administration disband the committee? "That's a bit of a grey area," says UC Law's Reiss. Federal committees are created by charter, and ACIP's charter is up for renewal in April 2026. "If the charter expires, or if the charter is abolished, they should cease to exist," she says.
But ACIP has been referenced in a few statutory provisions, such as its role in decision-making for the Vaccines for Children program. "The question becomes, who gets those powers if you abolish ACIP? Because the powers are still there and Congress hasn't cancelled those programs," Reiss says.
And it's possible to undermine the committee's credibility without dissolving it, Modlin says. "If you interfere with ACIP's process, people could lose confidence in the committee and its recommendations. You could reach a point where the function and advice of the committee means little to nothing," he warns.
And ACIP is just one of several policy levers controlled by the HHS secretary, says Katelyn Jetelina, an epidemiologist and author of the health newsletter Your Local Epidemiologist. HHS oversees the Food and Drug Administration as well, so Kennedy could change the review process for future vaccines, or revoke emergency use authorization for existing ones.
He might also work with other government agencies to withhold funding from school districts with vaccine mandates — something Trump suggested on the campaign trail.
But the most immediate changes could come from the weight his words now carry, Jetelina says: "Continuing to sow doubt and confusion about vaccines from the most powerful office could profoundly impact Americans' ability to make evidence-based decisions in an increasingly noisy world."
Fewer people getting vaccines could mean that diseases currently under control could roar back.
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