ACIP September Votes with APHA Perspective: COVID-19, MMR, and Hepatitis B
Georges C.Benjamin, MD, executive director of the American Public Health Association, details practical implications for clinical teams.
Georges C. Benjamin, MD
Image credits: APHA
The ACIP’s September 18-19 meeting delivered clear, clinic-facing decisions and largely maintained the current playbook. The committee voted on the following:
- COVID-19: Maintain vaccination for people 6 months and older under shared clinical decision making. No prescription required.
- Pediatrics (MMR/Varicella): Give separate MMR and varicella doses before age 4, not MMRV, to reduce febrile seizure risk.
- Hepatitis B: Table the proposal to delay the newborn birth dose to 30 days; keep the current birth-dose schedule. Reaffirm universal HBV testing in pregnancy.
In practice, continue COVID-19 vaccination through shared decision-making, maintain the HBV birth dose at birth with universal prenatal testing, and administer separate MMR and varicella doses to children under 4. Coverage through VFC, Medicare/Medicaid, and commercial plans is expected to continue without new prescription requirements, and ACIP members urged CDC to publish clearer plain-language consent materials with transparent vote language aligned to the evidence-to-recommendation framework.
In an interview focused on the clinical implications of recent ACIP actions, Georges Benjamin, MD, executive director of the American Public Health Association (APHA), discussed evidence standards, ordering priorities, communication with high-risk communities, and guidance for pregnancy. What follows is a flowing article for a clinical infectious diseases audience.
Evidence Standards and ACIP’s Process
Clinicians continue to look to ACIP for clear, defensible recommendations, and Benjamin began by situating the committee’s role and current transition. He noted, “ACIP has historically been the gold standard for evidence based decision making around vaccines, and unfortunately, the new group that they're there are rookies.” Building on that point, he added, “They're learning to do this. Many of them don't have a good vaccine history, so they're really struggling to come up with good evidence based decisions in a way that is following the science and not following their own ideology and biases.”
He cited a recent call that aligned with clinical needs: “Quite recently, they made a decision about the COVID 19 vaccine, which basically said that anyone over the age of six months should be eligible for the vaccine in consultation with a healthcare provider, and that is actually probably the best decision that we could have gotten out of this, this group, although getting there was a pretty rocky, rocky road.”
What to Order and How to Counsel Now
With respiratory season approaching, practices are balancing ordering, coverage, and documentation. Benjamin encouraged planning for expected demand, explaining, “Unless the Department of Health and Human Services, who have not yet signed off on this throw us a curve, then I think that we should assume that people should order what they anticipate to be the need for their population, the healthcare population, to get both the COVID vaccine, the hepatitis B vaccine for kids, as well as the MMR vaccine.”
He also flagged a supply dynamic tied to MMRV: “The challenge is that they did just articulate MMRV, and instead that that shouldn't be used, and that's going to create a supply and demand problem for that particular vaccine. So there may be a shortage there, but for the others in this series of things I did at this meeting, I think normal amounts of vaccine and access should should apply.” On payer coverage, he concluded, “It looks like the insurance companies will pay for it again, unless the HHS gives us a curve some along the way, at least for 2020 this fall, and then going into 2026 we're probably in goodstead.”
Reaching Underserved Communities
Turning to equity, Benjamin underscored communication gaps and reduced public-sector promotion that could widen disparities. “We're always concerned about underrepresented populations because they don't get the messages they're not getting. We're not having broad go back, you know, back to school or vaccine campaigns,” he said, linking these gaps to policy and funding headwinds: “HHS has pulled back and supporting funding for vaccines. We have a couple states who are minimizing the engagement of their health departments in vaccinations, like Louisiana and Florida.”
He called for a stronger civil-society push: "I think it's going to be important that those of us in civil society get more involved with the media, that the media talks more about vaccines, that to the extent we can, we encourage people to get vaccinated, that we do as much media advocacy as we can,” and he emphasized near-term respiratory season goals alongside routine childhood vaccination: “encourage people to get their their flu shot, their RSV shot, and their COVID shot, doing this respiratory season, and then getting kids up to date on their childhood vaccines.”
He closed by naming who is most at risk and why: "I think that it's going to be important for us in civil society to really emphasize this, so that we can deal with these, these disparities between communities of color, low income communities, rural communities, those are the communities that more at risk of not getting vaccinated because they don't either have access to providers, access to vaccine or or the funding to to be vaccinated”
Guidance in Pregnancy
Addressing common questions in prenatal care, Benjamin aligned with major professional societies and reinforced clinician counseling. “Professional recommendations for Hepatitis B being delivered at pregnancy to protect your child is very important, and I the American College of Obstetrics and Gynecology and the American Academy of Pediatrics still firmly recommend that, and we certainly agree with those recommendations here at the American Public Health Association that pregnant women are better off if they get vaccinated for COVID,” he said. He also highlighted shared decision making with obstetric providers: “Like any medication. It's important to consult with your healthcare provider as part of that process, and I encourage pregnant women to do so as part of that process.”
Finally, he addressed the current discourse on medication safety: “In addition, we most recently have seen that the administration, of course, has disparaged the use of Tylenol in pregnancy, and again, Tylenol under consultation with your doctor, use as prescribed is safe and effective for pregnancy.”
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