Advisory Committee on Immunization Practices

Based on Wikipedia: Advisory Committee on Immunization Practices

In June 2025, Robert F. Kennedy Jr. fired every single member of the committee that decides which vaccines Americans should get. Then he replaced them with anti-vaccine activists.

This wasn't some obscure bureaucratic shuffle. The Advisory Committee on Immunization Practices—known as ACIP—is the group that determines the entire vaccination schedule for the United States. Every shot your pediatrician recommends for your child, every flu vaccine your pharmacist offers each fall, every travel vaccine your doctor suggests before an international trip: ACIP decides all of it.

When ACIP speaks, insurance companies listen. Under the Affordable Care Act, any vaccine that ACIP recommends and the Centers for Disease Control and Prevention (CDC) Director approves must be covered by insurance with zero out-of-pocket cost. Medicare Part D follows the same rule. Most private insurers fall in line too.

So what happens when the fox takes over the henhouse?

How ACIP Became the Gatekeeper of American Vaccination

The committee traces its origins to 1964, when the U.S. Surgeon General created it to help control communicable diseases. The idea was straightforward: gather fifteen experts in immunization, preventive medicine, vaccine research, and public health. Have them review the scientific evidence. Let them vote on which vaccines work well enough to recommend to every American.

For six decades, that's essentially what happened.

The committee meets three times a year, with meetings announced in the Federal Register and open to the public. Anyone can watch via webcast. At least eight members without conflicts of interest must be present to vote. When they approve a new vaccine or modify an existing recommendation, the CDC Director reviews it. If approved, the recommendation gets published in the Morbidity and Mortality Weekly Report—the CDC's official publication—and becomes federal policy.

This isn't just bureaucratic theater. These recommendations have teeth. They determine which vaccines get purchased through the Vaccines for Children program, a federal initiative that provides free immunizations to kids who might otherwise go without. They shape what doctors recommend in exam rooms across the country. They influence which shots schools require for enrollment.

The Evidence Machine

Since 2010, ACIP has used a system called GRADE—Grading of Recommendations Assessment, Development and Evaluation—to evaluate vaccines. It's a methodical process designed to strip away bias and marketing hype.

The committee reviews everything: the FDA-approved labeling, the scientific literature on safety and efficacy, cost-effectiveness analyses, disease statistics showing how many people get sick and die without the vaccine, recommendations from other expert groups, and practical questions about whether the vaccine can actually be delivered through existing healthcare infrastructure.

Each piece of evidence gets rated as very low, low, moderate, or high quality. Problems like small sample sizes, unreliable study designs, or potential biases knock the rating down. Only after this exhaustive review does the committee vote.

Vaccines deemed appropriate for nearly everyone in a certain age group or risk category receive a Category A recommendation—think of it as a strong endorsement. Category B recommendations are softer, suggesting the vaccine might be right for some people after discussing it with their doctor. Both categories trigger the insurance coverage requirements.

Working groups do the heavy lifting between meetings. These teams of ACIP members, CDC staff, and outside experts spend months cataloging safety data and reviewing scientific studies for specific vaccines. They don't vote—their job is to ensure the full committee has complete information when decision time comes.

Who Guards the Guardians?

ACIP has strict rules about who can serve. Members must be experts in immunization, clinical medicine, vaccine research, or community health perspectives. At least one member must understand the consumer side—how vaccination programs affect real families in real communities.

The conflict-of-interest rules are unusually tough by Washington standards. No one who works for a vaccine manufacturer can serve. No one with a vaccine patent can serve. Members must disclose their financial ties and recuse themselves from votes where they have conflicts.

A peer-reviewed study published in the Journal of the American Medical Association in August 2025 found that these rules had been working. The share of ACIP members with financial conflicts had dropped from 42.8% in 2000 to just 5% by 2024. Since 2016, the average conflict rate was 6.2% for ACIP—and almost all of those were research grants, not personal payments from pharmaceutical companies. Less than 1% involved consulting fees or other direct compensation from vaccine makers.

This matters because Kennedy justified his purge by claiming the committee was hopelessly compromised. In an op-ed for The Wall Street Journal, he cited a 2009 inspector general's report supposedly showing that 97% of members had conflicts of interest.

Experts called this claim misleading. Tom Frieden, who was CDC Director when that 2009 report landed on his desk, explained what actually happened: the 97% figure referred to incomplete paperwork—missing signatures, forms filled out wrong—not actual financial entanglements. Of the seventeen members Kennedy fired, sixteen had reported no conflicts at all. The seventeenth had disclosed a conflict and properly recused herself from relevant votes.

The Changing of the Guard

The drama actually started before Kennedy arrived. In January 2025, as the Biden administration wound down, Health Secretary Xavier Becerra rushed to fill eight ACIP positions. Four were newly created seats; four replaced members whose terms were ending in June. The appointees were described as strong immunization supporters, and the timing was transparently defensive—an attempt to insulate the committee from whoever came next.

That someone was Robert F. Kennedy Jr., confirmed as Health Secretary on February 13, 2025. Kennedy had spent years as one of America's most prominent vaccine skeptics, spreading what public health experts characterized as misinformation, disinformation, and propaganda through his organization Children's Health Defense.

On June 23, 2025, Kennedy dismissed all seventeen ACIP members. He appointed only eight replacements—barely half the committee's intended size. Paul Offit, a renowned vaccine researcher, identified at least two of the new appointees as anti-vaccine activists. One appointee, Michael A. Ross, withdrew before even attending a meeting. Kennedy announced five more appointees in September, but the committee remained smaller and dramatically different in composition from anything in its sixty-year history.

The Wall Street Journal's editorial board—not typically critics of Republican administrations—published a scathing assessment. Kennedy's statement about the firings, they argued, revealed "a deliberate effort to stymie vaccine development." His goal, they wrote, "is to eliminate incentives to develop vaccines."

What the New ACIP Has Done

The reconstituted committee wasted no time making changes.

At its first meeting on June 26, 2025—just three days after the purge—ACIP voted to recommend that most Americans receive influenza vaccines without thimerosal, a preservative that contains ethylmercury. Kennedy adopted this recommendation on July 22, making it official federal policy.

The meeting itself was unusual. Normally, CDC staff present the scientific evidence they've compiled through months of systematic review. That didn't happen. Instead, the presentation came from Lyn Redwood, who had previously worked for Kennedy's anti-vaccine group Children's Health Defense. Redwood described thimerosal as a neurotoxin. Her presentation was a variation of one she had posted to the CDC's website earlier—a version that referenced a study that did not exist. That phantom citation was removed before the committee presentation.

For context: the scientific consensus, established through numerous large-scale studies, is that the tiny amount of ethylmercury in thimerosal-containing vaccines does not cause harm. Ethylmercury clears from the body quickly and is chemically distinct from methylmercury, the form found in certain fish that can accumulate to dangerous levels. Nonetheless, thimerosal had already been removed from nearly all childhood vaccines by 2001 as a precautionary measure—before any evidence of harm emerged. The flu vaccine was one of the few holdouts, partly because thimerosal makes it cheaper to produce vaccines in multi-dose vials, important for mass vaccination campaigns.

In September 2025, ACIP voted to end its recommendation for the MMRV vaccine—a combination shot protecting against measles, mumps, rubella, and varicella (chickenpox)—for children under four years old.

Then came December 5, 2025, and the vote that health experts found most alarming.

The Hepatitis B Decision

For decades, ACIP had recommended that every newborn receive a Hepatitis B vaccine within hours of birth. The logic was compelling: Hepatitis B is a viral infection that attacks the liver. Adults who catch it usually clear the virus, but infants almost never do. About 90% of babies infected at birth develop chronic Hepatitis B, which can silently destroy their livers over decades, leading to cirrhosis and liver cancer.

The universal birth dose worked spectacularly well. Before the recommendation, about 18,000 infants and children were infected annually in the United States. By 2019, cases had dropped 99%.

On December 5, the new ACIP voted 8-3 to end universal newborn vaccination. Instead, they advised "individualized recommendations" based on whether the mother was infected with Hepatitis B.

The problem with this approach is obvious to anyone who has worked in a delivery room: sometimes mothers don't know their infection status. Sometimes test results haven't come back. Sometimes the paperwork gets lost. Sometimes infected mothers slip through screening entirely. The universal birth dose existed precisely because catching every at-risk baby through targeted screening proved impossible.

ACIP member Cody Meissner, one of the three who voted no, put it bluntly during the meeting: "We have heard that do no harm is a moral imperative. We are doing harm by changing this wording. And I vote no."

Constitutional Questions and Interstate Compacts

Even before Kennedy's purge, ACIP faced legal challenges. In the 2024 case Braidwood v. Becerra, the Fifth Circuit Court of Appeals considered whether ACIP's recommendations having binding legal effects—like triggering mandatory insurance coverage—violated the Constitution's Presentment Clause. That clause requires that officers exercising significant federal authority be nominated by the President and confirmed by the Senate. ACIP members are neither.

The court didn't rule that ACIP's role was unconstitutional, but it found a similar board's binding recommendations violated the Constitution and sent the question about ACIP back to the district court for further consideration. The case remains unresolved, adding legal uncertainty to the policy chaos.

Meanwhile, state officials began organizing their own defenses. The lack of trust in the reconstituted ACIP's recommendations prompted the creation of two interstate collaborations: the West Coast Health Alliance and the Northeast Public Health Collaborative. These groups represent an unprecedented fragmentation of American vaccination policy, with states preparing to make their own recommendations rather than follow federal guidance they no longer trust.

The Broader Pattern

Understanding what happened to ACIP requires understanding that it didn't happen in isolation. The committee's transformation fits into a larger pattern of changes to American public health infrastructure under the Kennedy-led Department of Health and Human Services.

During a Senate Finance Committee hearing on September 4, 2025, Kennedy acknowledged that several of his ACIP appointees had previously served as paid expert witnesses in lawsuits against vaccine manufacturers. These were people who had testified—for money—that vaccines caused harm. Now they were voting on which vaccines Americans should receive.

When confronted with the JAMA study showing that conflicts of interest had actually been at historic lows when he fired the committee, a Health and Human Services spokesperson didn't address the contradiction. They issued a statement saying only that "Secretary Kennedy is committed to eliminating both real and perceived conflicts to strengthen confidence in public health decisions."

Critics noted the irony: Kennedy had fired committee members with essentially no conflicts and replaced them with people who had financial stakes in vaccine litigation.

What This Means for You

If you're a parent, a patient, or simply someone who gets a flu shot each fall, the ACIP changes affect you directly.

Insurance coverage for vaccines depends on ACIP recommendations. As the committee pulls back recommendations, insurers may no longer be required to cover certain vaccines without cost-sharing. Your out-of-pocket expenses could increase. Your doctor's recommendations might diverge from federal guidelines. Schools might face pressure to weaken vaccination requirements.

More fundamentally, the evidence-based system that protected Americans from vaccine-preventable diseases for sixty years has been disrupted. The people now making recommendations include those who have built careers opposing vaccination. The scientific review process that once preceded committee votes has been replaced, at least in some cases, with presentations from anti-vaccine advocates citing nonexistent studies.

Other countries have similar bodies—the Joint Committee on Vaccination and Immunisation in the United Kingdom, the National Advisory Committee on Immunization in Canada, Germany's Standing Committee on Vaccination. All face their own political pressures. But none have experienced anything like America's 2025 purge and replacement of an entire expert committee with people holding contrary ideological commitments.

The American experiment in public health, one of the great success stories of the twentieth century, is being stress-tested in real time. ACIP's transformation represents one of the most dramatic chapters yet—a complete reversal of the committee's founding purpose, accomplished not through legislation or legal challenge, but through the simple act of firing everyone and starting over with different people who believe different things.

What happens next depends on many factors: court rulings, state-level responses, public opinion, and whether the diseases that vaccines prevent come roaring back to remind Americans why vaccination mattered in the first place. The first case of measles in a child who would have been vaccinated under the old recommendations. The first infant with chronic Hepatitis B whose mother's infection status was unknown at delivery. The first outbreak traced to a gap in coverage.

These things may happen, or they may not. Vaccines are so effective that populations can coast for years on residual immunity before outbreaks occur. But the infrastructure that maintained that immunity—the expert committees, the evidence reviews, the careful weighing of risks and benefits—has been fundamentally altered.

The guards have been changed. The question is whether anyone is still watching the gate.