The staff supporting the Advisory Committee on Immunization Practices (ACIP) were let go earlier this month in a sweeping round of layoffs that gutted entire departments of the US Centers for Disease Control and Prevention (CDC).
Most of the committee’s working groups, which pore over data and help set the agendas, haven’t met for months, and there was little communication from the staff even before they received reduction in force (RIF) notices during the US government shutdown.
The ACIP meeting planned for 22-23 October has been indefinitely postponed.
The changes mean the US government may not make routine vaccine recommendations for more than half of children in 2026, and they will likely affect the development and recommendation of new vaccines in the pipeline.
The ACIP made headlines in June when Robert F Kennedy Jr, the US health secretary, replaced all of the independent vaccine advisers with his own handpicked advisers, an unprecedented move.
Some of these advisers, as well as others added in September, are vocal anti-vaccine activists. But the work of the committee isn’t done only by the independent advisers; it is supported by CDC staff and outside experts on working groups.
The CDC staff provide logistical support and subject-matter expertise, and they make sure the committee follows rules and regulations.
The entire department is now “gone”, Demetre Daskalakis, former director of the National Center for Immunization and Respiratory Diseases, said last week at a press conference with Defend America Action. Only a designated federal official for the group remains, he said.
“CDC scientists are being held hostage by Robert F Kennedy Jr.,” Daskalakis added.
With the ACIP staff, “a lot of what they do is logistics,” said Kevin Ault, an obstetrician-gynecologist at the Western Michigan University Homer Stryker MD School of Medicine.
In recent meetings, “you’ve kind of seen that fall apart”, he said.
Some presentations weren’t available for the most recent meeting, and several Zoom links and microphones weren’t working. The language of the votes wasn’t distributed to the public or apparently to the advisers ahead of time, with one committee member objecting to a vote because of the lack of information. With the support staff now gone, such delays and mistakes may worsen.
It’s not just scientists and staff within the agency feeling the effects of terminations and shakeups.
The ACIP’s working groups are often composed of subject experts, local health department officials, and representatives from medical groups in addition to CDC employees. There are usually eight to ten working groups at a given time focusing on pathogens like influenza, respiratory syncytial virus (RSV), human papillomavirus (HPV), and cytomegalovirus (CMV).
“We usually do the very boring job of slogging through the data and deciding what information is most important to present at the public meeting,” Ault said.
Most working groups have not met in at least six months. Ault was in a meeting for the working group on RSV in June when the news broke that all 17 advisers on the ACIP – some of whom were leading the session – were being fired.
“They weren’t informed ahead of time. It was in the Wall Street Journal and somebody happened to be on the call and said, ‘Hey, did you guys know you just got fired?’” Ault said.
Since then, Ault has attended no meetings and received little word from staff.
“The only communication I’ve gotten has been usually the day of a scheduled meeting – that it’s been canceled. Other than that, I’ve not gotten much communication at all,” Ault said.
Ault was an ACIP member from 2018 to 2022. He has been on the flu working group on and off since the flu pandemic of 2009, and he’s chair of the scheduling committee.
“Most of them have not met in six months or more,” Ault said. “It’s been very fragmented and haphazard.”
The flu recommendations were published in August despite no meeting of the working group, which meant experts and medical groups had no input on the recommendations.
Representatives from some groups received an unsigned email in August saying their input was no longer needed. The disinvited groups included the American Medical Association, the American Academy of Pediatrics and the Infectious Diseases Society of America. Other representatives, including from the American College of Obstetricians and Gynecologists (ACOG), haven’t received word on whether they are still participating in the working groups, Ault said.
One apparent exception to the pause on working groups is the new Covid vaccine group headed by Retsef Levi, a professor of operations management at the MIT Sloan School of Management and one of the new vaccine advisers. It’s not clear who is on the Covid committee and whether they are following the usual processes for working groups.
Working group members have presented data at ACIP meetings since the shakeup. But they’ve been “sidelined”, Daskalakis said. “They’re only, in effect, providing data that frankly is being just criticized and ignored.”
A meeting planned for October has been rescheduled “TBD”, according to the ACIP website.
A vaccine schedule should be published by the CDC by 1 January, and Vaccines for Children – a program that provides vaccines to 52% of children in the US – depends on that schedule, Ault said.
Normally, the schedule would have been published in the Morbidity and Mortality Weekly Report (MMWR), but that publication is temporarily closed during the government shutdown. And the schedule would’ve been discussed at the October meeting.
“All the vaccines for children and to some extent adults are at risk if that job does not get done in the next two and a half months,” Ault said.
Gutting the committee also means promising new vaccines in the late stages of clinical trials may never be recommended, he added.
“I don’t know what the future holds for new vaccines that are on the near horizon. The path forward just seems very murky.”
With the termination of ACIP staff, “it’s like the operating system for the advisory committee is gone”, Daskalakis said. “The hardware is there, the software is there” – but there’s no way to make the system run, he said.
The RIFs, which also affected departments like human resources, could limit what happens with the committee in the future, Debra Houry, former chief medical officer for the CDC, said at the same press conference with Daskalakis.
“If they want to add any new members, HR is gone. The entire HR for CDC is gone. That’s who brings on the special government employees and new FACA [Federal Advisory Committee Act] members,” he said.
The ethics office was also entirely let go. If “these folks have a baseline conflict of interest, we’ll never know, because they’re not going to be assessed anymore by the ethics office”, Daskalakis said. “That’s another pretty significant red flag.”
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