First meeting of CDC vaccine advisers under RFK Jr. is mostly ‘business as usual’

Despite concerns that the administration might meddle with a committee of vaccine advisers to the Centers for Disease Control and Prevention, their first public meeting since President Trump’s inauguration followed its usual course.

Members of the Advisory Committee on Immunization Practices voted to expand the options for meningococcal vaccines and to lower the age of recommendation for RSV vaccines to include people aged 50 to 59 with certain risk factors. They also voted to recommend vaccines for the tropical disease chikungunya for travelers or lab workers who are likely to be exposed to the virus.

These recommendations go to the CDC director, who usually heeds them but ultimately determines whether or not they become policy.

Committee members also previewed topics such as flu and COVID vaccines that will be considered more formally in the next public meeting, scheduled for June.

A rescheduled meeting raises concerns

Over two days, members sat through detailed presentations on data and modeling for a range of vaccines – from mpox to flu, COVID and chikungunya – and asked questions to sharpen their assessments of the risks and benefits of different vaccines. The meeting got weedy at times, as the presenters and committee members dug into technical details, which is typical.

The committee had been scheduled to meet in February, but the event was postponed shortly after the confirmation of Robert F. Kennedy Jr. as secretary of the Department of Health and Human Services, which oversees CDC. The postponement heightened concerns about possible interference.

“I am encouraged that the proceedings of ACIP have resumed, giving the American public a window into the future of our nation’s vaccine policy in a time of great uncertainty,” Sen. Lisa Blunt Rochester, a Democrat from Delaware, said in an emailed statement. “As America faces measles outbreaks and a changing political landscape, the public deserves transparency.”

In watching the meeting, Katelyn Jetelina, an epidemiologist and data scientist, said, “It seems pretty much business as usual – and it’s sad that that is newsworthy.,” She writes the newsletter “Your Local Epidemiologist.”

Still, Jetelina said, there were nuances that reflect changes made by the Trump administration over the past few months. Trump’s team has made deep cuts to funding and resources for public health. The administratione also elevated individuals who have long questioned the safety and efficacy of vaccines, despite strong evidence supporting them, into positions of influence over research and policy.

Resource cuts were evident

Some effects were evident from the start. Technical issues plagued the beginning of the meeting and required a fresh link to the public livestream. “As you may have noticed, there have been some changes with the recent reductions in force, including our communications group, so I ask that you please be patient with us,” said Dr. Keipp Talbot, professor of medicine at Vanderbilt University and chair of the committee.

The resource cuts were top of mind for some committee members. Charlotte Moser, co-director of the Vaccine Education Center at the Children’s Hospital of Philadelphia, probed for declines in CDC’s ability to evaluate how safe vaccines are, and how well they work.

“Are all of those [data collection systems] still funded to actively collect data through this season and then in anticipation of next season?” Moser asked, after a presentation on the efficacy of the 2024-2025 flu vaccine. In response, CDC epidemiologist Sascha Ellington said three of four flu vaccine surveillance networks would continue operating and that one would be shut down.

Funding cuts are also affecting the response to the ongoing measles outbreak in Texas, according to a CDC presentation.

The outbreak started in late January and has grown to more than 600 cases across Texas, New Mexico and Oklahoma. “There are quite a number of resource requests coming in, in particular from Texas,” said Dr. David Sugerman, a senior scientist at CDC working on its measles response. The state recently lost several hundred million dollars in public health funding, in a federal clawback of COVID funds that began late last month. “The estimates are that each measles case can be $30,000-$50,000 for public health response work, and that adds up quite quickly,” he said.

Committee member Dr. Jane Zucker, adjunct professor in the Department of Community Health Sciences at SUNY Downstate School of Public Health, had worked on containing a New York City measles outbreak in 2018. She said that the outbreak, which had around 650 confirmed cases, cost more than $8 million to bring under control.

A new FDA representative raises safety questions

In addition to the official committee members, the meeting is attended by members from U.S. health agencies and professional medical groups.

For this meeting, the Food and Drug Administration was represented by Dr. Tracy Beth Høeg, a special assistant to the commissioner, who has criticized CDC for recommending school closures during COVID. She took the liaison seat previously occupied by Dr. Peter Marks, the top vaccine regulator at FDA who was forced to resign in March.

Høeg has questioned vaccine safety, and she raised concerns in this week’s meeting. Following a presentation on a study of the mpox vaccine in teens, Høeg said: “They excluded adolescents with underlying significant heart conditions and significant medical conditions. So I think it’s important for providers to keep in mind that … we don’t really know about the safety in those adolescents.”

Høeg asked about “bias in our estimates” in a presentation on influenza vaccine efficacy, arguing that vaccinated people may be overrepresented because they may be more likely to seek out testing. CDC staff responded that their studies are designed to account for these and other types of bias. “We’re confident that [the impact of bias] is minimal and that the estimates are accurate,” said Dr. Aaron Frutos, an epidemiologist with CDC.

Public comment in support of committee

When HHS postponed the meeting in February, the reason was “to accommodate public comment in advance of the meeting,” according to an HHS spokesperson at the time.

Those who were chosen by lottery to speak during the public comment period for this meeting praised the committee’s work. “They play a really crucial role in ensuring that vaccine recommendations are based on available evidence and are reviewed rigorously by scientists who are qualified to do so,” said Angela Rasmussen, a virologist at the University of Saskatchewan and co-editor in chief of the journal Vaccine. “It is essential for public trust and accountability that this occurs in a transparent and inclusive way that the public can observe and participate in.”