Retsef Levi, a member of the CDC’s Advisory Committee on Immunization Practices and professor of operations management at the Massachusetts Institute of Technology, signaled that the committee could revisit other vaccine recommendations in future meetings. Maya Homan/Georgia Recorder

This story was updated at 10:45 a.m. on Sept. 22.

ATLANTA —  A key vaccine advisory panel at the Centers for Disease Control and Prevention has indefinitely postponed a controversial change to guidelines on administering hepatitis B vaccines to newborn babies, and altered long-standing recommendations around COVID-19 vaccine access for children and adults, though a proposal to require prescriptions for all individuals seeking the shot narrowly failed. 

The panel also voted to reverse a decision they made only Thursday that would have prevented updated guidelines on the MMRV vaccine, which protects against measles, mumps, rubella and varicella, from applying to children enrolled in the Vaccines for Children program. 

Vaccines for Children is a federal program which covers the cost of vaccines for more than half of American children. The decision to implement different standards for children enrolled in VFC caused confusion among top health officials as well as some committee members when it was introduced Thursday. 

Jason Goldman, the president of the American College of Physicians who also serves as a liaison to the committee, criticized Thursday’s vote, arguing that the changes were not backed by scientific evidence. 

“Would you consider that the second vote actually revealed the truth, that you do not have the data or evidence to challenge the current standing and that there is no associated harm?” Goldman asked the committee.

The committee’s reversal on Friday standardizes the updated MMRV vaccine recommendations for all children. If ACIP’s recommendations are approved by CDC officials, doctors will be advised to administer separate MMR and varicella vaccines for all children under 4 years of age.

ACIP tables a rule delaying Hepatitis B vaccine for newborns

In what appeared to be another reversal, the panel shelved a resolution that sought to alter current CDC recommendations around hepatitis B vaccines for newborn children. 

The current three-dose series for hepatitis B, an incurable viral infection that attacks the liver, includes one vaccine administered to infants within 24 hours of birth, and subsequent booster shots given a month and six months after the initial dose. ACIP has been recommending a hepatitis B vaccine for all newborn babies since 1991, which resulted in a 99% drop in serious infections between 1990 and 2019.

If ACIP members choose to implement the changes at a later meeting, official CDC guidelines will recommend that pediatricians delay administering the first dose of the hepatitis B vaccine until 30 days after birth for all children whose mothers test negative for the disease.

The panel did not provide any evidence indicating that delaying the vaccine improved children’s health, or that there were any widespread or serious instances of harm caused by administering hepatitis B vaccines to newborns. However, some ACIP members also cast doubt on the accuracy of data showing the shot is safe.

“I think that there are gaps in what we know and understand about the effects of hepatitis B, particularly on very young infants,” said Vicky Pebsworth, a committee member who is a registered nurse and who sits on the board of the National Vaccine Information Center, which advocates for vaccine exemptions. “I think that the conclusion that we know that it is safe is, perhaps, premature.” 

Dr. Adam Langer, who serves as the principal deputy director of the CDC’s National Center for HIV, Viral Hepatitis, STD, and Tuberculosis Prevention, urged the panel to reconsider narrowing the recommendations.

“One of the primary reasons for recommending universal birth dose in the U.S. is to serve as a safety net for infants born to mothers with unknown test results,” Langer said during his presentation to the committee on Thursday. 

“To date, no country in the world has reverted from universal to selective birth dose recommendations,” he added.

The meeting, which was held at the CDC’s Chamblee campus, also inspired a demonstration organized by a group of former CDC workers, who dressed up as preventable diseases and waved signs to the passing cars while the meeting was underway. 

Cindy Weinbaum, who spent about a decade of her career at the CDC in the division of viral hepatitis, said she commended the committee for deciding to table a vote that would have changed the recommendations for hepatitis B vaccinations.

“I think it’s really commendable, actually, that they delayed this vote because they do not know the implications of not recommending a birth dose of hepatitis B,” Weinbaum said.

“So that was a nod to their lack of understanding of vaccine programs, vaccine science and the importance of certain vaccinations for kids,” she added.

Weinbaum said the proposal’s appearance on the committee’s agenda reflects the “vaccine nihilism that the current administration is supporting.” She said the shot given to newborns within the first day of their life has found itself in the “cross hairs of the anti-vax movement.”

“It’s because here’s this newborn baby and you’re very vulnerable, and sticking it with a needle is kind of a scary thing,” she said. “They just don’t understand that it’s even more scary to get liver cancer, and that’s really what we want to prevent.”

ACIP moves to center vaccine harm

Though the committee did not implement some of its more controversial proposals, ACIP’s new members have signaled that they would like to place a greater focus on examples of vaccine harm and adverse outcomes in future policy proposals.

They have also rejected widely embraced data on vaccine safety, choosing instead to focus on isolated cases and dubious studies, including one paper claiming that rats exposed to the COVID-19 vaccine exhibited “autism-like behaviors” that was eventually retracted by the journal that published it.

Some ACIP members, including Robert Malone, also pushed back against guidelines that advise vaccinating young children and pregnant women, arguing that there is a lack of data proving definitively that vaccines are safe. 

“The default should be the assumption that there is no intervention in the infant and the pregnant woman with the vaccine unless there is definitive evidence of safety,” Malone said.

But Dr. Cody Meissner, a professor of pediatrics and medicine at Dartmouth College who has served as a past committee member, pushed back against the argument that any medical intervention should be entirely risk-free.

“I just want to point out that it’s very, very difficult to prove the absence of harm, it’s simply not a practical objective,” Meissner said.

“I think it’s important for everyone to understand that no vaccine is 100% safe and no vaccine is 100% effective,” he added. “What’s important for the provider before administering a vaccine is to think about that particular patient and does the benefit of protection exceed any possible side effect from the vaccine.” 

But in a conversation with reporters after the meeting, Retsef Levi, an ACIP member and professor of operations management at the Massachusetts Institute of Technology, signaled that the committee could revisit other vaccine recommendations in future meetings.

“I think we need to review vaccines, in general, from time to time,” Levi said. “It’s part of a good process. I don’t think that I need now to single out one vaccine or another. I think that, in general, it’s actually in the mission of ACIP. . . to actually review every vaccine.”

Georgia Recorder editor-in-chief Jill Nolin contributed to this report.

Correction: An earlier version of this story mischaracterized ACIP’s 1991 recommendation for the first dose of the hepatitis B vaccine. The 1991 recommendation was for all newborn babies to receive the shot, but not specifically within the first day of being born.

A child receives a COVID-19 shot in Annandale, Va., in 2021. Virginia is among the states that have parted ways with new federal guidance restricting access to the vaccine. (Photo by Chip Somodevilla/Getty Images)

At least 17 states have taken steps to ensure broader access to the COVID-19 vaccine since last month, when the federal government significantly restricted eligibility for the shot.

Arizona, California, Colorado, Connecticut, Delaware, Hawaii, Maine, Massachusetts, New Mexico, New York, North Carolina, Oregon, Pennsylvania, Rhode Island, Virginia, Washington and Wisconsin have issued orders that aim to make it easier for people to get the COVID-19 vaccine. All but Virginia have Democratic governors.

Together, the moves represent an extraordinary state rebellion against the public health authority of the federal government.

For decades, states have followed the lead of the U.S. Food and Drug Administration and the federal Centers for Disease Control and Prevention on which vaccines Americans should get, and when they should get them. Now, rejecting the antivaccine stance of U.S. Health and Human Services Secretary Robert F. Kennedy, Jr., an increasing number of states say they will rely instead on their own public health experts and professional medical organizations for that advice.

Previously, the FDA recommended that the COVID-19 vaccine booster be available to anyone 6 months or older. But in August, the federal agency said the booster shot should be limited to two specific groups: people who are 65 and older, and anyone who is at least six 6 months old and has an underlying health condition, such as asthma or obesity, that increases the risk of a COVID-19 infection becoming severe.

Under the new guidelines, children under 18 without an underlying condition can only get the shot if a health care provider is consulted first, meaning parents can’t simply take their kids to a vaccination clinic or pharmacy.

“The American people demanded science, safety, and common sense. This framework delivers all three,” Kennedy wrote on the social media platform X on Aug. 27.

In June, Kennedy ousted the entire vaccine advisory committee at the CDC, replacing some of them with vaccine skeptics. The previous month, he announced that the federal government would no longer recommend that pregnant women get the vaccine.

Currently 43 states — all but Arizona, Florida, Georgia, Louisiana, Oregon, Utah and West Virginia, along with the District of Columbia — allow pharmacies to administer FDA-approved shots without a prescription, according to Amy Thibault, a spokesperson for CVS Health.

But the federal government’s new COVID-19 recommendations have sown confusion. Many people are unsure whether their local pharmacy will give them the shot without a prescription — and if so, whether their health insurance will pay for it.

In the 17 states that have acted thus far, governors and state public health officials are trying to clear up that confusion, empower pharmacists to administer the shot and, in some cases, mandate that insurers pay for it.

The latest state to act is Wisconsin. Democratic Gov. Tony Evers signed an executive order Monday directing state health officials to create policies that ease vaccine restrictions, and requiring insurers to keep covering the COVID-19 shot.

“Vaccines save lives, folks. Spreading fear, distrust, and disinformation about safe and effective vaccines isn’t just reckless, it’s dangerous,” Evers said in a news release. “RFK and the Trump administration are inserting partisan politics into health care and the science-based decisions of medical professionals and are putting the health and lives of kids, families, and folks across our state at risk in the process.”

In addition to Wisconsin, Colorado, Massachusetts and Rhode Island have required insurers to cover the shot, and Arizona Democratic Gov. Katie Hobbs’s executive order calls on state insurance regulators to “encourage” insurers to do so.

In many of the states, including Arizona, Colorado, Maine, Massachusetts, New Jersey, New Mexico and Rhode Island, the governor or the chief public health officer issued a standing order clarifying that pharmacies can administer the vaccine without a prescription.

Earlier this month, New York Democratic Gov. Kathy Hochul issued an executive order allowing pharmacies in her state to administer the shot to anyone 3 or older through October 5. The order can be renewed, pending action by the legislature.

And in Connecticut, Delaware and Pennsylvania, state authorities directed pharmacists to follow the vaccine recommendations issued by professional groups such as the American Academy of Pediatrics, the American Academy of Family Physicians and the American College of Obstetricians and Gynecologists.

North Carolina Democratic Gov. Josh Stein issued an order stating that pharmacies can administer the COVID-19 vaccine without a prescription to all adults over 65 and anyone over 18 with a broad range of underlying health conditions. Virginia’s top public health official issued a similar order.

Earlier this month, the Democratic governors of California, Hawaii, Oregon and Washington announced the formation of the West Coast Health Alliance to coordinate vaccine recommendations for their states. The states pledged to use guidelines based on advice from leading medical organizations.

Meanwhile, Republican-controlled Florida doubled down on Kennedy’s antivaccine stance, announcing plans to become the first state to phase out all vaccine mandates, including ending requirements that kids be vaccinated against dangerous diseases before enrolling in schools.

At a news conference earlier this month, Florida Surgeon General Joseph Ladapo said vaccine mandates are “immoral.”

“Every last one of them is wrong and drips with disdain and slavery,” Ladapo said of such requirements.

In Louisiana, Republican U.S. Sen. Bill Cassidy, who is a physician, suggested last week that state Surgeon General Ralph Abraham should issue a blanket prescription for anyone who wants the COVID-19 shot, the Shreveport Times reported.

Republican Gov. Jeff Landry responded angrily on X.

“The last time I checked you have a prescription pad, why don’t you just leave a prescription for the dangerous Covid shot at your district office and anyone can swing by and get one! I am sure big pharma would love you for that one!” Landry wrote.

Stateline reporter Shalina Chatlani can be reached at schatlani@stateline.org

In this photo illustration, a pharmacist holds a COVID-19 vaccine. States and clinicians are working on getting correct information on vaccines to vulnerable groups amid shifting federal guidance. (Photo illustration by Joe Raedle/Getty Images)

The state health department is recommending COVID-19 vaccines for all Wisconsinites 6 months and older and authorizing pharmacies to give the vaccine without an individual prescription.

In addition, Wisconsin’s insurance regulator issued guidance to health insurance companies that the shots are to be provided without a patient co-payment.

Both department declarations were issued Tuesday following Monday’s executive order from Gov. Tony Evers to protect vaccine access.

At the Department of Health Services (DHS), Dr. Ryan Westergaard, chief medical officer and state epidemiologist for communicable diseases, issued a standing medical order recommending the vaccine for all eligible Wisconsin residents this fall. With the order, no prescription is needed, DHS said.

The health department said its recommendation for the vaccine follows guidance from the American Academy of Pediatrics, the American College of Obstetricians and Gynecologists, and the American Academy of Family Physicians.

States, public health organizations and agencies have been stepping in to recommend the vaccines for COVID-19 and for other communicable diseases following a shift at the federal Department of Health and Human Services (HHS) away from vaccine recommendations under the administration of President Donald Trump and HHS Secretary Robert F. Kennedy Jr.

Kennedy, who has long embraced anti-vaccine views, has replaced the members of a CDC committee on vaccination with vaccine skeptics, and the body is expected to consider softening or eliminating some recommendations for the COVID-19 vaccine and some childhood immunizations. 

The Food and Drug Administration has narrowed its recommendations for the COVID-19 vaccine to people 65 or older, while public health advocates have called for maintaining the vaccine schedule for all ages.

The DHS order states it “is also intended to authorize vaccination for other groups for whom professional society guidance supports vaccination — such as children, adolescents, pregnant people, and healthy adults under 65 — even though these uses are considered ‘offlabel.’”

“Everyone in Wisconsin should be able to make the choice to protect themselves and their families against COVID-19, and that choice should be based on the best available science and medical recommendations,” DHS Secretary Kirsten Johnson said in a department statement. “As the federal government limits access to the vaccine, we want to reassure Wisconsinites that recommendations from our nation’s leading medical associations are clear, and we will work every day to support access to care and resources to help families make the best decisions on how to protect themselves from illness and disease.”

The Office of the Commissioner of Insurance (OCI) said in a bulletin that based on “the evidence-based guidance” from DHS and state laws against discrimination in insurance coverage, “the commissioner continues to expect that all governmental self-funded and fully insured group health plans and individual health plans will cover, without cost sharing, all costs associated with administration of COVID-19 vaccinations for all policyholders.”

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