The ACIP Meets on September 18 as Vaccine Policy Hangs in the Balance

As the health care sector readies for this week’s meeting of the Advisory Committee on Immunization Practices (ACIP), the nation could be heading into “unknown territory” for vaccine access and cost, said a physician public health expert.

Meanwhile, health insurance plans will continue to cover shots recommended by ACIP as of September 1, including COVID-19 and influenza inoculations, through the end of next year. At least 3 professional organizations are publishing their own vaccine recommendations and resources for physicians and patients to study the shots’ safety and efficacy. The developments came ahead of the 2-day ACIP meeting scheduled to start September 18.

Changing the childhood immunization schedule?

On September 17, Susan Monarez, PhD, the fired director of the U.S. Centers for Disease Control and Prevention, testified in the Senate Committee on Health, Education, Labor & Pensions that Health and Human Services Secretary Robert F Kennedy, Jr, said he plans to change the childhood immunization schedule this month.

Her testimony followed a report by The New York Times that the U.S. Food and Drug Administration was examining deaths of young people who received COVID-19 vaccines. This week, The Washington Post and KFF began publishing survey results that showed 1 in 6 people delayed or skipped at least 1 vaccine for their children, other than flu and COVID-19 shots.

New members appointed

This week, Kennedy announced five new members of ACIP. It was unclear if they would participate in the meeting. But relatively close timing did not prevent in-person or online attendance of new members when Kennedy fired the previous ACIP members and appointed the new ones before the panel’s June meeting.

Insurance will pay

AHIP, the trade group for America’s health insurance payers, announced its intention, at least through the end of 2026.

“Health plans are committed to maintaining and ensuring affordable access to vaccines,” the AHIP statement said. “Health plan coverage decisions for immunizations are grounded in each plan’s ongoing, rigorous review of scientific and clinical evidence, and continual evaluation of multiple sources of data.”

“Health plans will continue to cover all ACIP-recommended immunizations that were recommended as of September 1, 2025, including updated formulations of the COVID-19 and influenza vaccines, with no cost-sharing for patients through the end of 2026.

“While health plans continue to operate in an environment shaped by federal and state laws, as well as program and customer requirements, the evidence-based approach to coverage of immunizations will remain consistent,” the AHIP statement said.

Feelings among physicians

Three doctors said they are awaiting the results of the ACIP meeting in hopes of reducing confusion among physicians and patients.

In Texas, Dallas Health and Human Services has no COVID-19 vaccine and won’t get any until there’s an ACIP recommendation, said Director Philip Huang, MD, MPH, a family physician. Staff are trying to be flexible with funding and partnerships, but the department lost $4 million to cover immunization efforts, he said.

Right now, there is a lot of uncertainty about vaccine recommendations and insurance coverage options, or patients paying out of pocket, Huang said.

‘Unknown territory’

He spoke to the media in an online meeting with David Margolius, MD, an internist and director of public health for Cleveland, Ohio, and Muntu Davis, MD, MPH, a family physician and health officer of Los Angeles County in California. The online meeting was organized by the Big Cities Health Coalition.

The other physicians agreed on murky direction coming from the federal leaders. Margolius called it “unknown territory” for medical recommendations and the means of paying for them.

“We're concerned about what's happening at the federal level,” Margolius said. “There were a lot of really brilliant people who are experts on vaccine research and the study of diseases, infectious diseases, who all got fired at the same time from the group that gave recommendations on vaccines.

“And the folks who have been nominated to replace them don't seem to have the same background and extensive vaccine research, and so when they produce recommendations, we're concerned that those are going to be more related to their political ideology and their ideological beliefs than what the research is showing,” he said.

In Cleveland, the health department will have flu shots available. Margolius also praised AHIP because lack of insurance coverage would be a huge barrier for residents. The city saw a drop in flu vaccine rates last year, and a rise in the number of adults and children with flu, including some deaths, he said.

Viruses and bacteria are nonpolitical

Local health departments are at the forefront of translating state and national recommendations into local action, Cleveland director of public health Davis said.

“Now, we're deeply concerned about actions that have compromised the integrity of the CDC guidance and undermined public health professionals who work there tirelessly to protect our communities, and we know that public health is inherently nonpolitical,” Davis said. “We also know that viruses and bacteria don't care about political affiliation or geographic borders, and so our role is really to serve everyone and protect every community from disease, whether ensuring that our ocean water is safe from the risk of bacteria or by containing infectious outbreaks at a school, a work site, or within a specific area of our jurisdiction.”

Davis spoke about potential effects on the Vaccines for Children program, a federal program that provides recommended shots for free for children who are uninsured, underinsured or Medicaid-eligible. Not giving some shots to children could put vulnerable patients at risk, he said.

“Now any changes in vaccine recommendations must be made with a clear understanding of both the science, in terms of why it changed and the downstream effects on access, especially for those who rely on publicly funded programs,” Davis said.

West coast recommendations

The California Department of Public Health this week issued its own respiratory virus immunization guidance, noting that changes to state law will maintain vaccine insurance coverage and access. The guidance was issued with West Coast Health Alliance partners Oregon, Washington and Hawaii.

“We want the people who live and work in our states to know that there is a strong public health, health care and scientific community that will continue to stand together to provide and use the data and evidence needed for them to make healthy choices, and we are here to protect our communities,” CDPH Director and State Public Health Officer Erica Pan, MD, MPH, said in the announcement. ​

The department noted by law its recommendations are informed by scientific study of “trusted national medical organizations,” including the American Academy of Pediatrics, American College of Obstetricians and Gynecologists, and the American Academy of Family Physicians.

Internal medicine recommendations

This week, the American College of Physicians updated its Adult Immunization Resource Hub with “Vaccines: Decision Making Amid Conflicting Recommendations.” It summarized an expert panel that the college convened this month to discuss vaccines. The authors also ripped Kennedy’s actions regarding ACIP.

“The trusted scientific infrastructure for vaccine policies has been dismantled and replaced with a process designed to yield recommendations aligning with the ill-informed beliefs of the US Secretary of Health and Human Services,” the article said. ACP’s panelists, moderated by President Jason Goldman, MD, discussed 3 potential situations that physicians could face: “prioritizing vaccines for patients hesitant to receive multiple vaccinations due to concern about side effects and out-of-pocket costs, vaccination during pregnancy, and adult patient concerns about measles immunity.”

ACIP agenda

ACIP’s online agenda shows there will be an update on work groups and review of vaccines for measles, mumps, rubella and varicella (MMRV) and hepatitis B on September 18. Discussion about COVID-19 vaccines is scheduled for September 19. There are published presentation materials, such as slides for the safety reviews.

For hepatitis B, the safety data available for the vaccine administered at birth did not identify an increased risk for allergic reaction, all-cause mortality, expected or unexpected deaths or deaths due to sudden infant death syndrome, or seizure or neurologic disease other than seizures. The vaccine reduced risk for invasive diagnostic procedures and a reduction in positive cultures, and for bronchopulmonary dysplasia, according to the presentation materials for that vaccine.

For MMRV, there is a small increased risk for febrile seizure after the first dose of MMR and MMRV vaccines. The risk is slightly higher with the MMRV combination vaccine after the first does, but there was no increased risk of febrile seizures after vaccination with the MMRV vaccine in children aged 4 through 6 years, according to the presentation materials.

For COVID-19, the presentation, “Vaccine safety signal detection and evaluation,” cited the Vaccine Safety Datalink (VSD). It is created from electronic medical records and chart reviews of 13 integrated health care organizations that treat more than 15.5 million people a year.

“The VSD detected statistical signals for ischemic stroke during 2022-2023 and 2023-2024,” the presentation said. “Signal evaluation using self-controlled case-series analyses in the VSD and in other data sources have not confirmed an increased risk of ischemic stroke.”