The Evolving Childhood Vaccine Schedule: Current ACIP’s Differing Meeting Approach

Our roundtable series, Clinical Insights: Childhood Vaccine Schedule Changes, discusses the ongoing changes being made to the pediatric vaccine schedule, the inner workings of the current Centers for Disease Control and Prevention’s (CDC) Advisory Committee on Immunization Practices (ACIP), and how all of this is impacting US public health.

For clinicians and other interested stakeholders who have attended or participated in previous ACIP meetings they remark how things have changed under the current Health and Human Services leadership.

For example, William Schaffner, MD, past medical director of the National Foundation for Infectious Diseases (NFID) formerly served as NFID liaison to the ACIP. He was an active participant in these meetings and explains how they operated.

“First, they did something called the grade assessment of the quality of the evidence. So they looked at all the information related to the vaccine—the same information and perhaps more had been accumulated that had been presented to the Food and Drug Administration—so all the information about effectiveness and safety of the vaccine,” Schaffner said. “They then moved to an evidence-to-recommendations framework in which they assess critically and objectively, the extent of the public health problem: the risks and benefits of vaccines, safety, the feasibility, the acceptability, the cost effectiveness, and the equity of the possible recommendations that are being presented. It's all done in an open, transparent fashion, in a rigorous fashion that was the previous ACIP.”

He said the current ACIP proceedings are a major departure from the past.

“The current ACIP isn't following any of those. And I would add the members of the ACIP had the additional participation of what are called liaison representatives from a variety of professional communities. The American Academy of Pediatrics, the American Academy of Family Physicians, and others who could participate with their wisdom and knowledge about vaccines, but didn't vote. The voting members were the members, but the whole discussion was enriched in that fashion. Those persons have now been excluded from the discussion, and we're not getting scientifically unbiased, rigorous presentations before the committee—I'm profoundly sad to say.”

Sharon Nachman, MD, chief of pediatric infectious diseases, Stony Brook Children's Hospital, says the makeup of the new ACIP members has changed and many have not been in the clinical care setting.

“When I looked at the prior ACIP committees, I looked at professionals that had actually seen these diseases and cared for children with those diseases and understood not only the science but also the impact on families,” Nachman said. “What we have now in ACIP are, in fact, for the most part, not pediatricians, not pediatric infectious doctors, and more importantly, not people who have actually seen these diseases in our local communities…The ACIP group that is voting now has never taken care of those kids. They've never seen the disease, and when they say, ‘We don't have this disease here,’ it is because the vaccines were effective.”