CDC’s ACIP Vaccine Advisory Panel Lacks Leader and Voting Members

Opinion | In making decisions about which vaccines should or should not be given to people and when developing childhood, adolescent and adult vaccination schedules, the U.S. Centers for Disease Control and Prevention (CDC) heavily relies on recommendations provided by an outside group of 15 medical and public health professionals, who make up a panel known as the Advisory Committee on Immunization Practices (ACIP). Members of the ACIP are selected and appointed by Secretary of the U.S. Department of Health and Human Services (DHHS).^{1 2 3 4}

The ACIP, which typically meets three times a year at CDC headquarters in Atlanta, Georgia, “develops recommendations on how to use vaccines to control disease in the United States.” The ACIP’s recommendations, which are approved by majority vote, are then provided to the director of the CDC, who usually endorses and adopts them as official CDC policy. The recommendations are subsequently published in the CDC’s Morbidity and Mortality Weekly Report (MMWR).^{3 4}

Of the 15 members of the ACIP, 14 members have experience in vaccinology, immunology, pediatrics, internal medicine, nursing, family medicine, virology, public health, infectious diseases, or preventive medicine. One member is designated to serve as a consumer representative to provide “perspectives on the social and community aspects of vaccination.”⁴

In addition to the 15 voting members of the ACIP, the panel includes 30 non-voting representatives from trade associations such as the American Academy of Pediatrics, American Academy of Family Physicians, American College of Nurse Midwives, American College of Obstetricians and Gynecologists and the American College of Physicians.⁴

ACIP Releases Vaccine Recommendations for 2024

The most recent ACIP recommendations for the 2024 childhood, adolescent and adult vaccination schedules were made public on Jan. 11, 2024. Changes suggested by the ACIP for this year’s childhood and adolescent schedule included:

… new or updated recommendations for influenza vaccine, pneumococcal vaccines; respiratory syncytial virus monoclonal antibody (RSV-mAb)—birth through 18 months; respiratory syncytial virus vaccines (RSV)—during pregnancy; COVID-19 vaccines; inactivated poliovirus vaccine (IPV); Mpox vaccine (Mpox)—18 years or older; and meningococcal serogroups A, B, C, W, Y vaccine (MenACWY-TT/MenB-FHbp.⁵

The ACIP vaccine recommendations for this year’s adult schedule included:

…new and updated recommendations for respiratory syncytial virus vaccines (RSV), influenza vaccines, COVID-19 vaccines, inactivated poliovirus vaccine (IPV), Mpox vaccine (Mpox), and meningococcal serogroups A, B, C, W, Y pentavalent vaccine (MenACWY-TT/MenB-FHbp).⁶

According to the ACIP, “This year’s schedule is particularly important because many adults are not up-to-date on recommended vaccines.”⁷

ACIP Lacks Chairperson and More Than Half Its Voting Members

The ACIP is central to helping set vaccination policy in the United States, yet the panel has been allowed to operate at less than half strength since the summer of 2023. STAT News reported last week that there have been eight vacancies on the panel since July 2023—one of those going back to 2022—and the terms of four of the remaining eight members are scheduled to end in June 2024. This important panel has also been conducting business without a leader. It has no chairperson.^{8 9 10}

“I really don’t know why,” Louisiana’s State Health Officer Joe Kanter, MD said. “From what I understand, what I’ve heard, the CDC has forwarded quite some time ago, their nominated individuals to the larger department, the federal HHS and HHS just hasn’t moved on it. … This is a real head scratcher.”⁸

Has ACIP Become Dysfunctional and Do CDC Officials Make Vaccine Policy in a Silo?

Dr. Kanter believes that staffing gaps in the ACIP makes it difficult for the panel to properly do its job to ensure that the vaccines it reviews meet the “safe and effective” standards it is charged to uphold. He noted:

Look, the vaccine manufacturers, the pharmaceutical companies, if they had their way, recommendations for their vaccines would be brought… They want the largest market possible. So they have a lot of lobbyists that try and expand the body of individuals who would be recommended to get a vaccine, like you would expect any lobbyist in that position to do. That’s just the reality of it.¹¹

Kanter added:

It’s the job of [the ACIP], which is made up of experts… pediatricians, immunologists, researchers… to actually look at the data, to look with a very critical eye at the studies which the vaccine manufacturers sponsor, compare that to studies that were truly financially independent, and to make the best decision on behalf of the American people. It’s a very important counterbalance to whatever information the vaccine manufacturers are putting in front of people. And it has to be staffed with qualified individuals. To have the committee half-ass now, that’s really taking the […] out of its work.¹¹

One of the main concerns about the lack of an ACIP chairperson and enough voting members is that government officials tasked with developing and regulating vaccines and making vaccine use recommendations, rather than outside physicians and scientists, will serve on the advisory panel as temporary voting members to ensure there is the required quorum for meetings. This practice severely limits the independent oversight and guidance that ACIP is supposed to provide to the CDC, which serves to increase the public’s lack of confidence in federal vaccine policymaking.¹²

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