AILSA CHANG, HOST:
In an unprecedented move, secretary of Health and Human Services, Robert F. Kennedy Jr., is replacing all members of the Advisory Committee on Immunization Practices, or ACIP. It's a committee that plays a key role in setting CDC policies around vaccine schedules and access. The move set off alarm bells in the public health community. So we called Michael Osterholm to explain the potential impact on public health in the U.S. He's the director of the Center for Infectious Disease Research and Policy at the University of Minnesota. Welcome.
MICHAEL OSTERHOLM: Thank you.
CHANG: So first just tell us real briefly here, what is the role of the ACIP? Like, how important is their work for people trying to make everyday health decisions or get access to vaccines?
OSTERHOLM: Well, let me first just start out by explaining very briefly how vaccines actually come about. They first have to show that they are safe and effective, and that is a review that is done by the Food and Drug Administration. But before the actual agency takes on that decision, they actually have another group that they bring in called VRBPAC, which is like ACIP but it addresses specifically safety and effectiveness. Then once it passes through there, it's moved to the CDC to this committee called the Advisory Committee on Immunization Practices...
CHANG: Right.
OSTERHOLM: ...Which includes 17 experts from around the country who have real expertise in understanding, how should this vaccine be used? Who's the groups that it should be recommended for and how? And that is a very, very important consideration because how we pay for vaccines in this country is tied in large part are they recommended or not? So for many people, if a vaccine is not recommended, even though we believe that they could benefit from it, they will very likely have to pay for that vaccine. And so this committee is very important.
CHANG: Do you expect the CDC's vaccine recommendations will change because of these changes to that committee?
OSTERHOLM: Well, one of the things that's happening right now is we are watching basically what I would consider to be over 60 years of good public health practice literally thrown out the window. And what I mean by that is that we have now, in a sense, eviscerated all of ACIP in terms of its expertise. Yesterday, all 17 members were basically fired from ACIP, and it's going to be repopulated by individual picks that Mr. Kennedy is going to make.
CHANG: And we don't know those picks yet.
OSTERHOLM: And we don't know who they are, but given his entire emphasis on reducing vaccine availability, it shouldn't be a surprise what we might hear about. And so this committee, which in the past, has really been a wonderful example - the best of bringing science practice to public health policy - is now no longer there. And the criticisms that Mr. Kennedy used for deciding this - which, by the way, had never been done before in the history of the ACIP dating back more than 60 years...
CHANG: You mean removing all 17 members?
OSTERHOLM: Yes, losing all 17 members and have it being done by a individual who has no real expertise in vaccines. You know, he is a secretary that comes in as a lawyer, and his closest expertise to vaccines has been the mis- and disinformation campaigns he is sowing...
CHANG: Well, he has accused the members - the current members of the ACIP - of having conflicts of interest. I think that's where you were going. Do you feel there is any merit to that claim?
OSTERHOLM: No, that's - there's no merit at all. And in fact, let me just be really clear. Dating back to 2000, when the first issue first came up about that, there was some issues raised about, did some members have conflicts of interest? In 2009, an inspector general's report came out saying that there were problems with the process at CDC. But it turned out all of them were - the papers weren't filled out correctly, the wrong dates or the wrong information was entered in the wrong place. Not one of those had anything to do with someone having a real conflict of interest. Since 2009, in fact, there has been no examples at all - zero - of someone having a conflict of interest, where - they all have to be disclosed. You can go to the CDC website right now and see all these members' disclosures.
CHANG: OK.
OSTERHOLM: And in that case, they have to take the time that is devoted to a given topic that they have a conflict with, and they cannot participate during that time.
CHANG: Let me ask you specifically about children here because the CDC recommendations include guidelines for when adults and kids should receive vaccines for common illnesses. How might this move by Kennedy affect the vaccine schedule for infants and small children, specifically, you think?
OSTERHOLM: Well, right now, children would not be recommended for the primary series that - you know, after their birth like we have had for the past several years. But let me just take a step back and say, when they talk about vaccine in children and not necessary, this past winter, which was not considered part of the pandemic, the actual incidence of severe illness, hospitalizations and deaths in children with COVID was similar to that we saw with influenza. We recommend influenza vaccine but not recommend COVID vaccines, or at least give...
CHANG: All right.
OSTERHOLM: ...Parents the option of that.
CHANG: Michael Osterholm is the director of the Center for Infectious Disease Research and Policy at the University of Minnesota. Thank you.
OSTERHOLM: Thank you very much. Transcript provided by NPR, Copyright NPR.
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