RFK Jr.-led vaccine panel declines COVID-19 booster recommendation, tightens MMRV guidance

A vaccine advisory committee handpicked by U.S. Health and Human Services Secretary Robert F. Kennedy Jr. met this week in Atlanta to weigh revisions to recommendations for COVID-19 vaccines, hepatitis B, and a combined measles, mumps, rubella and varicella vaccine (MMRV). The 12-member Advisory Committee on Immunization Practices, or ACIP, was formed after Kennedy dismissed the previous panel, and it took up whether to loosen, tighten or maintain existing guidance as the fall vaccination season approaches. In a departure from past practice, the group declined to issue a broad COVID-19 vaccination endorsement, instead signaling that individuals and their clinicians should decide whether to receive the shots. The panel’s wavering stance on a fall booster comes as public interest in the vaccine remains high and as federal agencies navigate a period of renewed questions about vaccine policy.

The panel’s discussion on COVID-19 vaccines occurred against a backdrop of new FDA restrictions that narrowed this year’s shots from Pfizer, Moderna and Novavax to people over 65 or younger individuals at higher risk. CDC data show the virus remained a continuing threat, with an estimated 32,000 to 51,000 U.S. deaths during the most recent fall and winter period. By not endorsing the vaccines for any age group, including seniors and other high-risk populations, the panel effectively left the decision to receive a booster to individual choice and clinician judgment. Several members urged the CDC to use stronger language around reported risks, despite pushback from some outside medical groups who note the vaccines have a safety record spanning billions of doses globally. The decision also skirted the question of whether states should require access or prescriptions for boosters, a line that some state policymakers had anticipated would be explicit in the panel’s recommendations.

The panel also considered the vaccine that protects against measles, mumps, rubella and chickenpox (MMRV). In an 8-3 vote with one abstention, the committee recommended that children under age four should not receive the combined shot. Instead, they should receive separate vaccines for MMR and varicella (chickenpox). The group cited concerns about rare feverish seizures that can occur after the first dose in this age group and noted that, while these events can be frightening for families, they do not appear to affect long-term brain function or school performance. The 2009 ACIP decision already allowed either approach for the first dose, but the panel’s current vote would tighten guidance in favor of separate shots for younger children. Presenters cited that about 85% of children already receive separate doses for the initial vaccination, suggesting limited disruption for many families while raising questions about access and scheduling for others.

On hepatitis B, the birth-dose issue drew particular attention. The panel indefinitely postponed a vote on whether to continue vaccinating newborns immediately after birth for infants born to mothers who test negative for hepatitis B. Some panelists questioned whether the birth dose is necessary for all babies, arguing that delaying the first shot could be appropriate in certain cases. Outside experts who have long supported the birth-dose approach urged caution against revisiting a policy that has helped cut infant hepatitis B infections by more than half since its routine adoption in 2005. The discussion highlighted a broader debate about balancing longstanding public health successes with any new considerations about whom to vaccinate and when. If the acting CDC director adopts the panel’s guidance, federal programs that influence vaccine coverage and payment—such as Medicaid and the Vaccines for Children program—could see immediate effects on funding and access. The panel also voted to align Vaccines for Children coverage with its MMRV guidance, a move the group had initially rejected before Thursday’s reversal.

The composition and conduct of the panel drew sharp scrutiny. All 12 members were chosen by Kennedy after he dismissed the previous, longer-tenured panel, and several members have publicly criticized vaccines or spread misinformation in the past. Critics argued that the panel’s makeup and the direction of its deliberations could undermine public trust in vaccines during a moment when vaccination rates are already slipping. Dr. Sandra Fryhofer of the American Medical Association called the process troubling and suggested the panel’s proceedings risk eroding the public’s confidence in immunization. Chairman Martin Kulldorff acknowledged the learning curve, saying, “We are rookies. There are many technical issues that we might not grasp as of yet.” He also noted that at times the group had to revisit votes to ensure they reflected their intent. Outside observers described the meeting as chaotic at times, with some members citing papers from animal studies that are not generally applicable to human outcomes. The committee’s recommendations now move to the CDC director, who typically adopts ACIP guidance, and then to doctors, insurers and state policy makers.

Industry and patient groups watch the process closely. America’s Health Insurance Plans, which represents major insurers, said its members would continue covering the current vaccines through 2026, underscoring the persistence of financial considerations in vaccine policy. The meeting’s outcomes also underscore broader concerns about how policy shifts at the federal level translate into everyday access for families and communities. In a year when the nation again debates booster timing and pediatric vaccination schedules, health officials stressed the importance of clear, evidence-based guidance to help clinicians communicate with patients and support informed decisions. As the CDC and other agencies weigh the next steps, public health advocates cautioned that mixed messages could hamper efforts to maintain routine vaccination rates and protect vulnerable populations from preventable diseases.