4 ways to anticipate next week's ACIP

A big vaccine policy meeting: What to expect, pre-bunking, and some answers to your questions

Next week (June 25-26), ACIP—the external committee that sets vaccine policy in the U.S.—meets. Normally, these meetings barely make headlines. They happen three times a year and are usually a routine part of the bureaucratic process determining who gets vaccines and how they’re made available.

Figure created by Your Local Epidemiologist

But these aren’t normal times.

This will be the first meeting since RFK Jr. dismantled the previous committee of 17 and replaced them with eight handpicked members—ranging from anti-vaccine activists to Covid-19 contrarians (i.e., mRNA kills and masks are child abuse) to some with genuine expertise. At this meeting, they’ll discuss fall vaccines for Covid, flu, and RSV, vote on a handful of new policies, and review routine vaccinations. What they say or decide could ripple across insurance coverage, government vaccine programs (which serve nearly half of U.S. kids), school entry requirements, and create widespread confusion.

Here are four things to anticipate: the new members, topics I expect to bubble up on social media, some answered (and unanswered) questions, and some hope.

Note: If you have no idea what I’m talking about, catch up here first before moving on.

1. Time to meet the members

When these new members were appointed, RFK Jr. framed it as “restoring trust,” “bringing in experts,” and “following gold-standard science.” He pointed to credentials like MDs and PhDs.

Those of us raising concerns about this new committee also talk about trust, expertise, and science, but we’re using those words to sound the alarm. One of the most disorienting parts of this moment is that it’s turned into a game of he said, she said.

My advice: don’t focus on the words alone, but on the actions behind them. Trust isn’t declared; it’s earned and demonstrated consistently. Research shows trustworthiness rests on three pillars:

• Credibility: Do they bring real expertise?

• Believability: Are they transparent and genuine?

• Relatability: Do they reflect and understand the communities they serve?

Through this lens, RFK Jr.’s new ACIP falls short even before it enters the meeting. This is important to understand intent:

Credibility: Several new members have little or no vaccine experience. Peer-reviewed publications aren’t a perfect measure, but they’re a useful proxy, and this group severely lacks vaccine training compared to the last committee. This seems important if they are making vaccine decisions for 330 million Americans.

Just last week, one new ACIP member, Robert Malone, proudly declared himself “anti-vaxx.” When someone says this, believe it. As you may recall, he recently blamed a child’s death on medical errors, not measles, a textbook disinformation tactic to deflect from the disease’s preventability.

Believability: RFK Jr. has already inaccurately stated basic facts about his appointees, claiming one has an MD (he doesn’t) and another holds an academic position he left eight years ago. Many have conflicts of interest, from profiting off litigation to building media empires rooted in sowing doubt. One appointee disclosed more conflicts during prior service than all 17 former members combined. The new committee hasn’t disclosed any of this.

Relatability: This is where this group gains traction. They tap into genuine frustrations with a broken health ecosystem, anger over pandemic policies, and distrust of institutions, but channel that into dangerous falsehoods.

During the meeting, CDC scientists will present data. But then the new members will debate, ask questions, and, in some cases vote, directly shaping U.S. vaccine policy.

2. Expect confusion fueled by falsehoods

The newly posted ACIP agenda includes typical topics like flu and Covid-19 vaccines, but two last-minute items were added that raised red flags to me:

• Thimerosal-containing flu vaccines

• MMR vaccination in kids under 5

These topics have long been cornerstones of vaccine falsehoods among vaccine skeptics. Next week, I expect the new members or their associated organizations, like Children’s Health Defense, to amplify them during the meeting or on social media.

Here’s some quick context to help you navigate the noise:

• Thimerosal in flu vaccines: Thimerosal (an ethylmercury-based preservative that keeps vaccines safe from bacterial contamination) was largely removed in 1999 as a precaution, even though no harm was ever demonstrated. At the time, there wasn’t data specifically on ethylmercury’s toxicity, so safety assessments conservatively applied methylmercury (the toxic kind of mercury many of us are used to hearing about) limits. Using those stricter benchmarks, cumulative exposure from the full childhood schedule slightly exceeded what was considered safe for prenatal methylmercury exposure. Since then, countless studies have shown ethylmercury is processed differently and is safe at the levels used in vaccines. For now, the CDC website does a fantastic job of explaining the nuances. I’ll keep a close eye on this if it changes.

• MMR vaccine. I don’t know what they will go after here. Maybe febrile seizures, which are a very small risk after vaccination (1 in 3,000) and don’t compare to the risk of infection or baseline risk in the general population (2-5%). False claims linking MMR to autism may also resurface. Check out more here.

I would also brace for rumors on RSV vaccination during pregnancy and Covid-19:

• RSV vaccines and preterm birth: After the RSV vaccine was approved for pregnant women, extra scientific scrutiny (rightfully so) was applied because of a slight, non-significant signal for preterm births in one clinical trial site in South Africa. However, thereafter, a number of studies, including a U.S. study from nearly 3,000 deliveries in 2023–2024 showed no increased risk: 5.9% of vaccinated pregnancies resulted in preterm births vs. 6.7% among unvaccinated. The RSV vaccine is far safer than the disease itself.

• Covid-19 mRNA vaccines and death: There are rare vaccine tragedies that need to be taken seriously, but they certainly are not common occurrences. (And don’t forget that Covid-19 vaccines saved millions of lives across the globe and will continue to do so.) Go here for a YLE deep dive on this topic.

3. We will have some answers, but not all

Don’t expect full clarity next week. The entire process has been flipped on its head. We don’t know what checks and balances remain within the federal government, how insurers or state regulators will respond, or what will happen next.

For example, the vote on the Covid-19 vaccine was quietly pulled from next week’s agenda, which means we may not have an official recommendation. What this could mean to you in the fall remains to be seen.

Also, the vote to strengthen HPV vaccine recommendations — for a vaccine that has the potential to eliminate several types of cancer — was pulled from the agenda. As The Atlantic noted, this may be one of the first vaccines targeted by the new ACIP, given some members’ track record of casting doubt on it. Its future is uncertain, but no changes will happen next week.

Here are a few answers I can offer now:

• Who will step in if the government is out? Nothing can replace the U.S. government, but the Vaccine Integrity Project—an outside group created in anticipation of RFK Jr.’s move—will meet this summer to discuss fall vaccines. Professional organizations, like the American Academy of Pediatrics, American Medical Association, and American College of Obstetricians and Gynecologists, will continue making evidence-based recommendations. Ideally, these groups will coordinate to minimize public confusion.

• Will my insurance cover a vaccine my doctor orders if it is not ACIP-recommended? Insurers aren’t necessarily bound to ACIP. They would likely make decisions based on costs, and preventing illness is far cheaper than treating it. For example, it’s far cheaper to cover a Covid-19 vaccine during pregnancy than a NICU stay.

• Would it be possible to get vaccines in Canada if necessary? Yes.

• What vaccines could be taken off the market at this meeting? ACIP will vote on recommendations for RSV and flu vaccines, including those with thimerosal. Votes on other routine vaccinations, like MMR, polio, HPV, and Hep B, are not on the docket.

• Would removing thimerosal-containing flu vaccines cause a shortage? I would expect this ACIP group to recommend removing them. The good news is that this only accounts for a small percentage of flu doses in the U.S. (5-7%), so we won’t run out of supply. The greater harm would be to public confidence, particularly globally, where many are still used.

4. Expect lots of people stepping up

Many organizations (and the hundreds of thousands of clinicians and scientists they represent) have already strongly opposed these developments. In addition, the American Medical Association called for a Senate investigation, and the American Academy of Pediatrics is ramping up a strong social media presence.

In addition, while much of this feels uncertain, many are already mobilizing behind the scenes. Professional societies are coordinating. Public health leaders are meeting with insurers. State health officials are preparing. Health communicators are ready to counter falsehoods online. You may not see most of this work, but it is happening.

The vast majority of clinicians and public health workers nationwide care deeply about your ability to access vaccines, protect your family, and make informed decisions. They are still fighting for you. I hope this provides hope.

Bottom line

I’d say grab your popcorn—if this meeting didn’t have such serious implications for you, your family, or your patients’ health. There are more unknowns than answers, and the next few weeks may get (even more) confusing. However, many in public health are already hard at work ensuring you have access to evidence-informed information and care.

I’ll be back with ACIP Cliff Notes next week.

Love,
YLE

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Your Local Epidemiologist (YLE) is founded and operated by Dr. Katelyn Jetelina, MPH PhD—an epidemiologist, wife, and mom of two little girls. YLE is a public health newsletter that reaches over 375,000 people in more than 132 countries, with one goal: to translate the ever-evolving public health science so that people are well-equipped to make evidence-based decisions. This newsletter is free to everyone, thanks to the generous support of fellow YLE community members. To support the effort, subscribe or upgrade below: