The Advisory Committee on Immunization Practices (ACIP) to the Centers for Disease Control (CDC) holds its regular annual meeting June 26-28, 2024. Votes were scheduled on COVID, Vaxelis, RSV, PCV21, and influenza. Spoiler: All sailed through unanimously. There was one recusal on Day 2: New member Dr. Yvonne Maldonado is involved with Pfizer’s RSV and COVID trials, as well as varicella (chickenpox).
After needing federal workers to fill in as voting members in February, the ACIP has some new members, but they are still trying to fill three spots. If you’d like to apply, applications are due in August!
The CDC’s Demetre Daskalakis opened Day 2 with an agency update, and at one point declareddeclaring, “Vaccines work, even when they don’t,” when explaining that people who got the mpox vaccine and still got mpox had a milder infection.
In case you missed it, this is the new messaging for vaccines, We used to be told they’d stop transmission, but now vaccines are used to make infections milder.
Below is a clip of the agenda and presentations for COVID.
This represents a typical ACIP presentation order.
1) Fear: Look at all the hospitalizations from the illness.
2) But we have an effective solution — cue the vaccine!
3) Don’t worry, it’s safe.
4) And it will save us money in the long run, once we get the initial massive investments.
5) A very large presentation of all the things we’re looking at to assure you we’re making a reasoned decision (including equity!),
6) How do we get more shots in arms? (aka What doctors should say to patients,)
After such presentations, some members may have questions. They may even push back a little, cite a slide, and say, “Can you explain that number more because it doesn’t add up.” They may say they don’t agree or aren’t sure yet. But then we get to votes. And in this June meeting, as in many others, the yeses are unanimous.
There was a lot of talk about how to increase vaccinations, of course. The CDC is planning to go all out with messaging again and primary providers have been at the forefront of changing minds. It was noted that older adults are less influenced by their providers, but that’s because they already have higher uptake of vaccines and don’t need convincing. But CDC data showed that younger generations were more likely to get a shot after their doctor recommended it. We anticipate the CDC to be reaching out to primary providers who serve younger generations to push them to promote vaccines. This can be especially dangerous in states that have minor consent laws that would allow children to get immunizations outside of parental knowledge. Talk to your kiddos this summer about your family values and give them permission to say no to someone who asserts their authority when you’re not present. Be extra vigilant about School-based Health Centers, if your district has one.
On the flip side, there’s encouragement for health providers to increase their standing orders for older adults to get vaccines. This means the growing list of CDC-recommended vaccines for adults will be presumed as standard care and could be administered without a doctor’s consult. If you’re caring for an older adult, make sure they’re aware of their vaccine rights, and that they do not need to get a shot simply because it’s offered.
The ACIP had seven votes over two days, all of which were unanimously approved.
- RSV guidance for adults 75 and older was strengthened from “shared clinical decision-making” to a recommendation instead.
- The recommendation for RSV was extended down to 60-74 year olds60–74-year-olds who are at heightened risk. (Notably, a vote on lowering the age to 50 was postponed so the ACIP can see more data on the emerging cases of GBS[EC1] associated with the RSV shot.)
- Vaxelis was added to the preferential recommendation for American Indian and Alaska Native infants to make sure they get a dose of the Haemophilus influenzae Type B (Hib). It was noted this means babies would be getting an extra unnecessary dose of Hep B vaccine but it was decided that was okay.
- Vaxelis was added to the Vaccines for Children program to give permission to the federal government to purchase it.
- The ACIP voted to recommend the FDA’s “authorized or approved” COVID shots.
- A new 21-valent pneumococcal vaccine, PCV21, which was recently approved by the FDA, was added to the list of recommended pneumococcal shots.
- Influenza
- High Dose Influenza vaccine was recommended as an option for people on immunosuppressant drugs.
Stand for Health Freedom applied to make an oral public comment, but we were told we were not chosen in the lottery. This happened for the February 2024 meeting as well and it wasn’t the first time.
On Friday, the ACIP will hear presentations on meningococcal vaccines and RSV vaccines for pregnant women and infants. The last session scheduled before the meeting is closed will announce the formation of an HPV work group. We can presume this group will be talking about the new Merck HPV vaccines in the pipeline, announced in March.