This article, about how the ACIP is undermining access to vaccines, was written by Dorit Rubinstein Reiss, Professor of Law at the University of California Law, San Francisco, who is a frequent contributor to this and many other websites, providing in-depth and intellectually stimulating articles about vaccines, medical issues, social policy, and the law.

Professor Reiss writes extensively about the social and legal aspects of vaccination in law journals. Reiss is also a member of the Parent Advisory Board of Voices for Vaccines. This parent-led organization supports and advocates for on-time vaccination and the reduction of vaccine-preventable diseases. She is also a member of the Vaccines Working Group on Ethics and Policy.

When the newly reconstituted Advisory Committee on Immunization Practices (ACIP) meets on December 4-5, it will discuss two key topics: the hepatitis B vaccine birth dose, which has nearly eliminated childhood cases of the liver-damaging disease, and the vaccine schedule, which has been carefully tested and monitored for decades. In other words, they will attempt to make some of the most well-established vaccine safety science appear controversial.

How ACIP should work with vaccines

Since 1964, the ACIP has given careful, science-based guidance to states and healthcare providers on the best way to protect Americans from preventable diseases. The Committee achieved sufficient respect that states, of their own volition, have looked to it to guide their own immunization practices and choose immunizations for their school-entry requirements. Congress gave it the power to determine the scope of a federal benefit program covering over 50% of children whose families cannot afford vaccines, the Vaccines for Children Program.  When the Affordable Care Act was enacted, Congress once again entrusted ACIP with determining which vaccines insurers would have to cover.

ACIP is supposed to operate through workgroups populated by experts and advised by liaison organizations with considerable expertise, such as the American College of Obstetricians and Gynecologists and the Society for Healthcare Epidemiologists. These workgroups prepared lengthy presentations and voting language that were presented to the entire committee in public meetings.

The Committee would typically hear data about a topic over three meetings before a vote, and the vote would draw on clear, professional frameworks for decisions. It used a framework called Grading of Recommendations Assessment, Development, and Evaluation (GRADE) to transparently discuss the quality of the evidence presented to the committee, and a framework called Evidence to Recommendation (EtR)  to assess additional factors such as “public health problem, benefits and harms, values, acceptability, feasibility, resource use (including cost-effectiveness), and equity.” This made the discussion both transparent and thorough.

ACIP voting members were themselves leading experts in a variety of fields related to vaccines, such as virology, immunology, and specific clinical areas. Given their broad influence on vaccine access, ACIP members were chosen after a lengthy process of vetting, including examining their conflicts of interest. The Committee was supported by CDC staff who knew the requirements and the committee’s role. 

How ACIP seems to work now to undermine vaccine access

But all of that changed in February 2025. Robert F. Kennedy Jr., a long-time anti-vaccine activist, was appointed as Secretary of Health and Human Services. The Secretary promised Senator Bill Cassidy, whose vote was key in confirming his nomination, that he “will maintain the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices’ recommendations without changes.” As with his promise that he would not change the CDC’s page on vaccines and autism, Secretary Kennedy broke, if not the words of his agreement, clearly the spirit. 

In June 2025, Secretary Kennedy fired all members of ACIP via a paywalled op-ed in The Wall Street Journal. Members were not notified until after the publication – denied notice and any opportunity to be heard, even as the Secretary publicly accused them of essentially serving the interests of pharmaceutical companies over the public.

Since then, in two rounds, the Secretary appointed a new set of members. Very few of them had any scientific credentials related to vaccines, although most have publicly demonstrated an anti-vaccine bias. Out of the current 12 members, only six hold current academic or clinical positions, and one – Dr. Robert Malone – holds that position in a center that specializes in nutrition, not vaccines. 

In two meetings held so far, ACIP members have demonstrated a lack of understanding of their role, a lack of knowledge on basic vaccine issues, and strong anti-vaccine bias. Examples of this included: voting to test pregnant women for Hepatitis B, which is not within the committee’s purview; trying to vote for requiring prescriptions for COVID-19 vaccines – something that would both encumber access and is not within the Committee’s purview; and reversing a vote on VFC because they didn’t understand what it meant. The chair of the committee even had to admit, “We are rookies.” 

The vote language itself was bizarre. Some have begun with “It is the sense of the committee that…” as though the ACIP were a think tank. Perhaps that’s not surprising when you consider they have not used GRADE or EtR to help them make decisions based on clear, unbiased science. If you happened to tune into the discussion before the votes, you would have noticed that comments from members even included clear misunderstandings on vaccines. 

It was, in lay terms, a mess. 

December 2025 meeting

So will this time be any better? In the Federal Register notice about the meeting, it stated:

The agenda will include discussions on vaccine safety, the childhood and adolescent immunization schedule, and hepatitis B vaccines. The agenda will include updates on ACIP workgroups. Recommendation votes may be scheduled for hepatitis B vaccines. Vaccines for Children (VFC) votes may be scheduled for hepatitis B vaccines.

The initial draft agenda also has discussions of the immunization schedule and “adjuvants and contaminants.” It mentions “votes” with no more details. 

The Committee provided a comment period of about ten days, but how can experts offer commentary when the substance of the agenda items remains unknown? Which adjuvants and supposed contaminants? Beyond, of course, the aluminum that Secretary Kennedy has personally railed against for two decades despite its strong safety record. 

And in the lead-up to this week’s assignment, the Chair, Dr. Martin Kulldorff, moved to a position in HHS, and a new member was appointed chair, another person with no expertise in ACIP’s role (and little vaccine background). This does not promise better management of the Committee and its meetings. 

The only working group that has met recently is the one on COVID-19, which met in September to draft the unusual vote language noted above. There is no hepatitis B or vaccine schedule working group listed on their website. So, who is preparing the vote language? Who has even presented data that led working group members to recommend a vote? 

As Senator Cassidy pointed out, removing hepatitis B vaccines from many families’ reach can increase the rates of this dangerous infection among young babies. ACIP decisions affect insurance coverage and access, and yet this group appears to be completely unaware of the impact of their votes.

This is serious. Already, the Trump/Kennedy measles and pertussis outbreaks have killed multiple children in the U.S. Playing with language that can restrict access to vaccines is a dangerous game. It’s time to kick out the rookies and call back the veterans. Our country deserves better.