The US Department of Health and Human Services (HHS) is adopting a recommendation from independent advisers to drop thimerosal, a preservative found in about 4% of flu vaccines, despite evidence that it poses no risks and helps prevent bacterial and fungal infections.
But Robert F Kennedy Jr, the HHS secretary, has not adopted two other votes from the advisory meeting: recommending annual flu vaccines for everyone over the age of six months and RSV shots for infants.
As science becomes increasingly politicized and federal officials change policies on vaccination, sometimes reportedly over the advice of their own scientists, independent scientific groups are now stepping into the gap for evidence-based recommendations.
Medical groups now plan to issue vaccine recommendations in the wake of changes to routine vaccine guidance from the US Centers for Disease Control and Prevention (CDC).
Recommendations like these may help the public – and health insurance companies – understand which shots should be part of the routine schedule, and why.
The American College of Obstetricians and Gynecologists (ACOG) announced this month that it will release new guidance for Covid, flu and RSV vaccination during pregnancy. The guidance will appear at the end of the summer, before the winter respiratory season.
Five other scientific groups – the American Academy of Pediatrics, the Infectious Diseases Society of America, the American Academy of Family Physicians, and the American College of Physicians – also plan to release vaccine guidance.
The news comes amid growing changes to how vaccines are recommended by US officials.
Kennedy and other officials have also announced new restrictions on Covid vaccines, and Kennedy framed vaccination with the measles, mumps, and rubella shot as a “personal” choice during the worst US measles outbreak in three decades.
A new endeavor, the Vaccine Integrity Project, is now conducting a wide-ranging review of scientific studies on vaccines, due to wrap up in the next two to three weeks.
The volunteer-driven vaccine project is analyzing 16,400 publications on flu, Covid and RSV vaccines.
The scientific groups will then draw upon that review to issue guidance for the populations they serve, including children, high-risk people, pregnant people and healthy adults.
“We’re not making recommendations ourselves. We’re just providing them with the information,” said Michael Osterholm, the epidemiologist heading the project at the University of Minnesota’s Center for Infectious Disease Research & Policy (Cidrap).
It is an effort to take up the work done by the CDC’s independent advisory group, the advisory committee on immunization practices (ACIP), since 1964.
“For the past five-plus decades, we have looked at the CDC as the authoritative source for guidance and information related to vaccines,” said Scott Rivkees, associate dean for education in the Brown University School of Public Health and former surgeon general of Florida.
Now, “the medical community very much disagrees with” the current approach from health agencies, he said, and it is quickly pivoting from relying on CDC recommendations to collaborating on their own.
Americans are facing an “information crisis” as official guidance falters, Osterholm said. “The CDC science has been corrupted”.
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Changing official health guidance “results in total confusion”, Rivkees said. “Who do you listen to? It really puts parents and families in an incredibly difficult situation.”
Parents “have more questions now than before. We see more vaccine hesitancy than before. We see more vaccine refusal than before,” Rivkees continued.
“These changes that are happening now are the result of politics, not related to science.”
Organizations like the Vaccine Integrity Project and its collaboration with medical groups will be vital to “preserve what we know works” when it comes to protecting people from infectious diseases and other health issues, said Rivkees.
The scientific groups already have expertise – and trust – in these areas, he said. Working together will help them make evidence-based, trustworthy recommendations.
Kennedy announced in May that the CDC would no longer recommend Covid vaccines during pregnancy, despite strong and consistent evidence that the vaccines are safe in pregnancy and that pregnancy is a major risk factor for severe illness and death from Covid.
“Immunization is especially important during pregnancy, when the risks of severe outcomes are heightened – and when vaccines can provide critical protection to the infant after birth,” Sandra E Brooks, CEO of ACOG, said in a statement.
The CDC also changed the pediatric Covid recommendation from “should” to “may” and FDA officials put greater restrictions on who may receive Covid boosters.
Yet Covid remains a major threat.
“This year, the number of hospitalizations, serious illnesses and deaths in kids from Covid exceeded that of influenza, and this was one of the worst influenza years in a decade,” Osterholm said.
Flu and RSV also pose major risks, and without recommendations from the CDC for annual boosters, those vaccines and preventives could face an uncertain future.
The respiratory vaccine guidance is only the beginning, Osterholm said. “This was just the first effort, because it was the most immediate need right now.”
After this, the organization will focus on data for other routine vaccinations.
“The thought that we now have to care for more children with measles, more children with whooping cough than before, is really very unfortunate,” Rivkees said.
“I’m very afraid that this country is moving to a situation where some elements within our nation are going to accept children dying of measles, children dying of whooping cough, teenagers dying of meningitis, not getting vaccinated as the new normal. And the thought that we are going to now be able to think that this is acceptable is frankly terrifying.”
Outside guidance will help parents and providers navigate the evidence on vaccines, Rivkees said – and it may help insurers decide which vaccines to cover.
Under the Affordable Care Act, insurers are required to cover vaccines recommended by ACIP.
“As ACIP makes changes to recommendations, then the question comes, are these vaccines going to continue to be covered or not? Whereas before insurance may pay for certain vaccines, maybe they won’t in the future, which means families will have to pay out of pocket,” Rivkees said.
Decreases in vaccination could mean manufacturers make fewer vaccines or pull out of the market entirely. “The other thing that we’re also very worried about is what’s going to happen to the vaccine supply,” Rivkees said.
Vaccines help insurers save money by preventing illness, Osterholm said. “But they’ve got to have a basis for making the decision that ‘we will support this,’ and that’s what we’re trying to provide.”
The outside recommendations are meant as a stopgap measure, Osterholm says.
“We need our old ACIP back. We need to have the kind of scientific expertise, based on the expertise in the community, to ensure the vaccine enterprise is healthy and exists,” Osterholm said.
“We’re not, as the Vaccine Integrity Project, hoping that we exist for very long. We’d love to see us go away because of the return of ACIP and CDC leadership,” he added.
But, he said, “we know that that’s not going to happen, at least for the next few years”.
