The Advisory Committee on Immunization Practices (ACIP)–a decades-old federal advisory committee to the Centers for Disease Control and Prevention (CDC)–serves to provide expert advice to the CDC and the Secretary of Health and Human Services (HHS) and to create immunization policy guidance for American public health institutions and healthcare providers. Beyond providing the scientific basis to inform the immunization schedule, ACIP recommendations create access pathways to vaccination through insurance coverage mandates, pharmacy access, school entry requirements in some states, and, most importantly for many American families, inclusion in the Vaccines for Children (VFC) program, which provides free vaccines to nearly half of the nation’s children.
Since the dismissal of all 17 ACIP members in June 2025, VYF and many other leaders in public health have voiced concerns about the standards of evidence and scientific rigor the newly constituted ACIP is using to issue vaccine recommendations. While leading medical societies like the American Academy of Pediatrics (AAP), American College of Obstetricians and Gynecologists (ACOG), and the American Academy of Family Physicians (AAFP) continue to issue evidence-based recommendations, the recommendations issued by ACIP have a unique statutory role in determining vaccine coverage by most public and private payors and the VFC Program.
During the September 18-19, 2025, ACIP meeting, the Committee decided not to recommend the measles, mumps, rubella, and varicella (MMRV) combined vaccine for children under four years old and removed the vaccine from the VFC program for children under four years old. This removes the choice for the combined dose from parents and providers, despite the evidence-based recommendation that was already in place.
The committee voted to continue recommending COVID-19 vaccines for everyone 6 months and older but said the decision should be made in partnership with a person’s health care provider. This is broader than the FDA license (which means the CDC recommends off-label use) but less broad than medical societies, such as AAP. As not everyone has a health care provider, this creates barriers and additional confusion.
Additionally, for COVID-19 and hepatitis B the committee voted on provisions related to informed consent, Vaccine Information Statements (VIS), and testing during pregnancy. This added further confusion as much of what was voted on (including hepatitis B screening) is outside the authority of ACIP.
It is deeply concerning that none of the decisions made at this ACIP meeting adhered to decision-making frameworks designed to guide sound vaccine policy. The ACIP typically adheres to two frameworks (Grading of Recommendations, Assessment, Development, and Evaluation [GRADE] and Evidence to Recommendations [EtR]) to guide their policy recommendations. These frameworks allow the committee to weigh the evidence and make decisions that assess not only the research and evidence, but also the implementation of those recommendations. However, the decisions made at this ACIP meeting adhered neither to these frameworks nor a true weighing of the risks and benefits, as demonstrated by the contradictions between evidence presented by the subject matter experts and decisions made by the ACIP. Further, members clearly lacked understanding of the implications of their actions for our most vulnerable populations.
These decisions have real-life implications, removing provider and patient choice about vaccination against these four diseases (MMRV), creating increased implementation challenges for providers, and sowing confusion for parents and caretakers. All of this comes at a time when the U.S. is facing the worst measles outbreak in over three decades and has already lost three people to the disease this year, two of whom were children.
The U.S. will not continue to be a public health leader without rigorously developed public health policy. The American people deserve transparency and gold standard science – not substandard presentations touting cherry picked studies and uninformed policy decisions. Moving forwards, the ACIP must once again provide the public and public health community with the recommendation vote language in advance of the meeting and share publicly a complete EtR framework prior to any vote. We echo the concerns of ACIP liaison and committee members who stated repeatedly that there was no clearly defined public health problem requiring this body to reconsider the immunization schedule for hepatitis B and MMRV.
The evidence continues to demonstrate that vaccines work to prevent negative health outcomes and even deaths from dangerous diseases. Vaccines also prevent economic and health system burden to our communities and our caregivers. The ACIP’s recent actions removed parental and provider choice without evidence to support these decisions. The most appropriate way for our public health institutions to ensure the U.S. has the best childhood immunization schedule is by adhering to evidence and avoiding ideological interference in the recommendation process. Americans support vaccines, and our policies must support vaccine access–our children and nation’s health depend on it.