How America’s Fire Wall Against Disease Starts to Fail

For more than 60 years, vaccination in the United States has been largely shaped by an obscure committee tasked with advising the federal government. In almost every case, the nation’s leaders have accepted in full the group’s advice on who should get vaccines and when. Experts I asked could recall only two exceptions. Following 9/11, the Bush administration expanded the group who’d be given smallpox vaccinations in preparation for the possibility of a bioterrorism attack, and at the height of the coronavirus pandemic, in 2021, the Biden administration added high-risk workers to the groups urged to receive a booster shot. Otherwise, what the Advisory Committee on Immunization Practices (ACIP) has recommended has effectively become the country’s unified vaccination policy.

This might soon change. Robert F. Kennedy Jr., one of the nation’s most prominent anti-vaccine activists and the likely next secretary of Health and Human Services, has said that he would not “take away” any vaccines. But Kennedy, if confirmed, would have the power to entirely remake ACIP, and he has made clear that he wants to reshape how America approaches immunity. Gregory Poland, the president of the Atria Academy of Science and Medicine and a former ACIP member, told me that if he were out to do just that, one of the first things he’d do is “get rid of or substantially change” the committee.

Over the years, the anti-vaccine movement has vehemently criticized ACIP’s recommendations and accused its members of conflicts of interest. NBC News has reported that, in a 2017 address, Kennedy himself said, “The people who are on ACIP are not public-health advocates … They work for the vaccine industry.” Kennedy has not publicly laid out explicit plans to reshuffle the makeup or charter of ACIP, and his press team did not return a request for comment. But should he repopulate ACIP with members whose views hew closer to his own, those alterations will be a bellwether for this country’s future preparedness—or lack thereof—against the world’s greatest infectious threats.

[Read: ‘Make America Healthy Again’ sounds good until you start asking questions]

Before ACIP existed, the task of urging the public to get vaccinated was largely left to professional organizations, such as the American Academy of Pediatrics, or ad hoc groups that evaluated one immunization at a time. By the 1960s, though, so many new vaccines had become available that the federal government saw the benefit of establishing a permanent advisory group. Today, the committee includes up to 19 voting members who are experts drawn from fields such as vaccinology, pediatrics, virology, and public health, serving four-year terms. The CDC solicits nominations for new members, but the HHS secretary, who oversees the CDC and numerous other health-related agencies, ultimately selects the committee; the secretary can also remove members at their discretion. The committee “is intended to be a scientific body, not a political body,” Grace Lee, who chaired ACIP through the end of 2023, told me. ACIP’s charter explicitly states that committee members cannot be employed by vaccine manufacturers, and must disclose real and perceived conflicts of interest.

HHS Secretaries typically do not meddle extensively with ACIP membership or its necessarily nerdy deliberations, Jason Schwartz, a vaccine-policy expert at Yale, told me. The committee’s job is to rigorously evaluate vaccine performance and safety, in public view, then use that information to help the CDC make recommendations for how those immunizations should be used. Functionally, that means meeting for hours at a time to pore over bar graphs and pie charts and debate the minutiae of immunization efficacy. Those decisions, though, have major implications for the country’s defense against disease. ACIP is the primary reason the United States has, since the 1990s, had an immunization schedule that physicians across the country treat as a playbook for maintaining the health of both adults and kids, and that states use to guide school vaccine mandates.

The committee’s decisions have, over the years, turned the tide against a slew of diseases. ACIP steered the U.S. toward giving a second dose of the MMR vaccine to children before elementary school, rather than delaying it until early adolescence, in order to optimally protect kids from a trifecta of debilitating viruses. (Measles was declared eliminated in the U.S. in 2000.) The committee spurred the CDC’s recommendation for a Tdap booster during the third trimester of pregnancy, which has guarded newborn babies against whooping cough. It pushed the country to switch to an inactivated polio vaccine at the turn of the millennium, helping to prevent the virus from reestablishing itself in the country.

[Read: We’re about to find out how much Americans like vaccines]

I reached out to both current ACIP members and the Department of Health and Human Services to ask about Kenndy’s pending influence over the committee. ACIP Chair Helen K. Talbot and other current ACIP members emphasized the group’s importance to keeping the U.S. vaccinated, but declined to comment about politically motivated changes to its membership. The Department of Health and Human Services did not return a request for comment.

Should ACIP end up stacked with experts whose views mirror Kennedy’s, “it’s hard not to imagine our vaccination schedules looking different over the next few years,” Schwartz told me. Altered recommendations might make health-care providers more willing to administer shots to children on a delayed schedule, or hesitate to offer certain shots to families at all. Changes to ACIP could also have consequences for vaccine availability. Pharmaceutical companies might be less motivated to manufacture new shots for diseases that jurisdictions or health-care providers are no longer as eager to vaccinate against. Children on Medicaid receive free vaccines based on an ACIP-generated list, and taking a particular shot off that roster might mean that those kids will no longer receive that immunization at all.

At one extreme, the new administration could, in theory, simply disband the committee altogether, Schwartz told me, and have the government unilaterally lay down the country’s vaccination policies. At another, the CDC director, who has never been beholden to the committee’s advice, could begin ignoring it more often. (Trump’s choice to lead the CDC, the physician and former Florida congressman Dave Weldon, has been a critic of the agency and its vaccine program.) Most likely, though, the nation’s new health leaders will choose to reshape the committee into one whose viewpoints would seem to legitimize their own. The effects of these choices might not be obvious at first, but a committee that has less academic expertise, spends less time digging into scientific data, and is less inclined to recommend any vaccines could, over time, erode America’s defenses—inviting more disease, and more death, all of it preventable.