Last night at dinner, the kids wanted to play the usual battery of games like "would you rather," "rose, bud, and thorn," and "what's your favorite." My son Dylan asked: what's your favorite drink, to which my husband had the audacity to answer ‘water’. Now, even on a "normal" day, this answer would've made me raise an eyebrow (my wonderful husband decided to transform a room in our basement into a "brew room"—water, my behind!)—but on this day, a day when I cleared my schedule to tune in to 6+ hours of day 1 of the ACIP (Advisory Committee on Immunization Practices) meeting, the answer sent me into a spiral. I clutched my wine glass and contemplated a divorce (kidding, of course)—this day warranted something with a high proof, if you know what I mean.

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A refresher on the plan for ACIP—this September meeting is a 2-day meeting with three vaccines on the agenda: MMRV (measles, mumps, rubella, and varicella), Hep B, and COVID-19. I will admit the latter two are the ones giving me extra heartburn...the vote for Hep B was delayed to today, to prolong the torture a bit more.

I am working with a team of brilliant scientists to do a deep dive on what transpired (yesterday and today), so stay tuned for that. But instead, I want to focus on some things that stood out to me as notable—more of a gut versus brain analysis. And I want to give a shoutout to people who were following in real-time, like this Bluesky thread by Liz Szabo. Let’s discuss…

Fighting Words from the Get-Go

The meeting kicked off with fighting words from ACIP Chair Martin Kulldorff, who called out the recently resigned CDC officials (including former CDC Director Susan Monarez and former Chief Medical Officer Debra Houry), and the nine former CDC directors who penned a powerful op-ed warning that Kennedy was a threat to children's health. In a nutshell, he said that anyone who won't engage in debate can't be trusted. He challenged them to "a live public debate with me concerning vaccines," adding that if they refuse, "I advise that you should not trust them."

The timing was notable—just the day before, Monarez and Houry had testified to the Senate that Kennedy pressured Monarez to approve vaccine changes without scientific evidence and to fire career experts without cause. The contrast between calling for "open debate" while former officials testified about behind-the-scenes pressure was striking.

(Bold move for someone whose committee would later have members abstaining from votes because they literally couldn't understand what they were voting on. But I'm getting ahead of myself.)

He also made clear that he's not a fan of the AAP (American Academy of Pediatrics), which sat out this meeting (as well as the last one in June) in protest. AAP CEO Mark Del Monte told STAT News the current panel "imperils children's health" and that ACIP was once "the venue for rigorous debate rooted in sound science." Major medical groups that usually participate in these meetings were notably absent—a blatant vote of no confidence in the current process. When challenged about the removal of some medical organization liaisons from working groups, he claimed it was a FACA (Federal Advisory Committee Act) requirement, saying "this is a policy across all of CDC that is sort of outside the control of this committee."

Now, I am not a FACA expert, but after reviewing the ACIP charter, here's what's actually happening. The charter explicitly lists liaison representatives from medical societies like the AAP, AAFP, and others as part of the committee structure. These liaisons have traditionally participated in working groups, which are subcommittees that help develop recommendations before they come to the full committee.

The ACIP charter states that subcommittees can include "members of the parent committee and other subject matter experts" with approval from the Secretary or designee. The CDC Director has the authority to approve liaison participation. So when Kulldorff blamed FACA requirements for excluding medical society liaisons from working groups, he was seemingly being disingenuous. What actually changed was that the new leadership chose not to approve medical society liaisons for working group participation. This was a political decision, NOT a FACA requirement. These organizations can still present to working groups but cannot participate in deliberations, effectively silencing frontline medical expertise while maintaining pharmaceutical industry representation.

This selective exclusion of medical societies while retaining industry liaisons suggests the FACA explanation was pretextual—a bureaucratic justification for removing dissenting medical voices from the deliberative process.

We haven't even made it to the committee intros yet, folks!

Dog Whistles and Red Flags

There were a few breadcrumbs that I clocked in the intros. A reminder that 5 of the ACIP members were newly minted (appointed just this week!), so this was the first time we were seeing them in their new role. Some phrases like "pro medical freedom" and "pro informed consent" were casually peppered throughout. According to CBS News, Dr. Evelyn Griffin, an OB-GYN from Louisiana, called herself "pro-informed consent...because of medical ethics." Dr. Joseph Hibbeln said he has a "neutral mind towards vaccines." Dr. James Pagano made sure to clarify he's "not anti-vax" but rather "pro-intelligent and informed utilization." Of course, we are ALL for informed consent—but this is a bit of a dog whistle in the "vaccine critic" community. Just something of note.

Dr. Robert Malone, who has become a prominent vaccine critic, acknowledged that "a significant population of the United States has significant concerns about vaccine policy and vaccine mandates." This framing set the tone for much of what followed.

Getting into the presentations themselves, the CDC employees did an incredible job of presenting data. I legitimately have no clue how they do it. I would crumble like a Nature Valley granola bar in that setting (I will stick to writing, thank you very much!).

Some of the questions did raise concerns, like a question about whether adjuvant levels in MMR versus MMRV differ. I'm not an immunologist, but I know that these are live vaccines that don't require adjuvants. Again, just something to note.

But WHY Are We Talking About This?

Multiple times, people would question: but WHY are we talking about this now? We don't have new data? Febrile seizures are benign?

For context, the committee was debating whether to stop recommending the combined MMRV vaccine for kids under 4 because it carries a slightly higher risk of febrile seizures—about one additional seizure per 2,300-2,600 children compared to giving the vaccines separately. These seizures, while terrifying for parents, don't cause lasting damage and are essentially a high fever response.

One committee member invoked a single study out of China to imply there are long-term impacts of febrile seizures. This study, which looked at mice and theoretical mechanisms, is being used to override decades of real-world safety data from millions of children. It's like using a paper airplane design to question Boeing's safety record.

Have we thought through the implications of eliminating MMRV as an option for parents of kids under 4? (After 4 years of age, febrile seizures are exceedingly rare.) Some parents choose these vaccines because it means fewer shots for their babies. Why not give them that choice as long as they understand that there's a small risk of febrile seizure?

A Clear Lack of Understanding

Another thing that stood out was a lack of basic understanding of health equity and the ways that public health works. When we talk about the Hep B vaccine being a "safety net," we mean that YES, it is exceedingly rare for babies born to mothers who are Hep B negative to get Hep B so early in life...but this assumes we know whether the mother is Hep B negative. Not all mothers have equal access to prenatal care or regular screening. And tests are imperfect. We have a vaccine with an incredible safety profile that moves risk of Hep B to essentially zero when given at birth. According to CHOP's analysis, before routine vaccination, about 9,000 children every year were infected with hepatitis B from unknown sources—they never knew when, where, or how they were exposed. These weren't babies born to Hep B positive mothers; these were kids who got infected despite their mothers testing negative. Why are we suddenly questioning this?