RFK Jr.-selected panel votes to drop MMRV for under-4s, directing separate vaccines for chickenpox and MMR
Advisory committee votes 8-3 to discontinue recommending the combined MMRV shot for young children, citing safety concerns and parental practices
An advisory panel chosen by Health Secretary Robert F. Kennedy Jr. voted Thursday to stop recommending the combined measles, mumps, rubella, and varicella (MMRV) vaccine for children under age 4, instead directing that varicella be given separately from the MMR component for a first dose. The decision, reached by an 8-3 vote with one abstention, comes from the Advisory Committee on Immunization Practices (ACIP), which guides the Centers for Disease Control and Prevention on vaccines to recommend for the public. The panel’s recommendation now awaits final sign-off from the CDC’s acting director, Jim O’Neill, before it becomes policy.
Evidence presented at the meeting showed a small but persistent concern over fever-induced seizures associated with MMRV vaccines, a risk that has long been part of the vaccine discourse. Some panelists urged caution, while others argued the overall risk remains low in the context of protected populations. “Febrile seizures are a very frightening experience for parents,” said Dr. Cody Meissner, a panel member who voted to maintain the MMRV option for young children, according to coverage of the proceedings. The 2009 ACIP review already found that either a combined shot or separate MMR and varicella vaccines could be used for the first dose, but noted that separate injections were preferable for reducing seizure risk in some children.
The panel noted that the vast majority of parents—about 85%—already opt to give their children the varicella and MMR vaccines as separate injections for the first dose, a practice the panel cited as evidence that the new direction aligns with existing parental behavior and safety preferences. A later vote addressed whether to extend the more restrictive no-MMRV guidance to the Vaccines for Children (VFC) program, which provides free vaccines to low-income families. That motion passed along the same 8-3 line, with members stressing the potential for policy fragmentation if VFC and non-VFC recipients received different recommendations.
The ACIP’s actions come after Kennedy’s broader overhaul of the committee earlier this year, where he dismissed all 17 members and replaced them with his own picks in what he described as a bid to “re-establish public confidence in vaccine science.” The shakeup has fed into a larger conversation about vaccine policy and oversight, including questions about how new recommendations intersect with insurance coverage and access for the neediest families.
The debate on vaccine policy also touched other items on the agenda. The panel delayed a vote on whether to recommend against administering hepatitis B vaccine to newborns when the mother is not infected with hepatitis B, with a committee member arguing that the vaccine is safe and overlooking the immediate postnatal window might not be warranted. “This is an absolutely safe vaccine,” said Dr. Meissner, who questioned what would be gained by delaying the first dose within 12 to 24 hours after birth. Another panelist, Vicky Pebsworth, who directs research at the National Vaccine Information Center, questioned the sufficiency of current science to declare the hepatitis B vaccine definitively settled, a stance that reflected ongoing debates within vaccine discourse. The hepatitis B discussion is scheduled to resume on Friday.
The department that oversees public health, the Department of Health and Human Services, said it would examine insurance coverage implications before accepting ACIP’s recommendations. Insurers historically rely on ACIP guidance to determine coverage, and America’s Health Insurance Plans said it would continue to cover all ACIP-recommended immunizations that were in place as of September 1, 2025, including updated formulations of the COVID-19 and influenza vaccines, with no cost-sharing through the end of 2026. Kennedy has repeatedly argued that his approach is needed to restore public trust in vaccines, though critics say the upheaval may threaten continuity in immunization practices.
Former CDC Director Susan Monarez—fired by Kennedy last month after she refused to automatically approve ACIP recommendations—testified to lawmakers that she was pressured to rubber-stamp decisions regardless of the scientific evidence. Monarez told the Senate Health, Education, Labor and Pensions Committee that she was told to commit in advance to approving every ACIP recommendation, a claim Kennedy has denied. The exchange highlighted tensions over scientific integrity and the governance of vaccine policy at a pivotal moment for public health.
As ACIP’s recommendations must still be signed by the CDC’s acting director, the ultimate policy shift on MMRV for preschoolers will depend on that sign-off. If finalized, the new guidance would affect millions of families as well as state immunization schedules, which have historically aligned with ACIP recommendations and, in turn, with payer and school vaccination requirements. Health officials say the direction is intended to minimize seizure risk while preserving access to vaccines; however, the political and organizational upheaval surrounding ACIP has created new questions about how quickly or uniformly the recommendations will be implemented across states and insurance plans.
Public health advocates and opposition voices alike will be watching how the policy unfolds in the coming weeks as the CDC finalizes its language and insurers decide how to apply the new guidance to coverage, including the Vaccines for Children program and any related co-pay or access provisions. In the meantime, the panel’s vote underscores a continuing tension between vaccine safety data, parental preferences, programmatic logistics, and political leadership shaping how vaccines are recommended and funded in the United States.
The finalization process remains in flux as agencies weigh scientific findings against policy considerations and access concerns. Kennedy’s camp argues that reshaping ACIP is essential to restoring confidence in vaccine science, while critics warn that abrupt leadership overhauls can sow confusion and disrupt routine immunizations. The next steps will hinge on O’Neill’s review, the administration’s willingness to align insurer practices with the updated guidance, and the ability of public health officials to communicate the reasoning behind any adjustments to families who rely on vaccines for their children’s health.
