The ACIP's Rich History of Debate is in Jeopardy, Not A Good Sign for Science, ID Expert Says

Infectious disease specialist, vaccine expert, and public health and policy advocate William Schaffner, MD, has been deeply involved with the Advisory Committee on Immunization Practices (ACIP) and participated in its workgroups for decades. In a recent interview with Patient Care Schaffner's concern and distress over the series of abrupt and precipitous changes within and around the ACIP were palpable over Zoom.

His immediate concern is also an overarching one and that is that the expected, welcomed, and necessary debate that has always surrounded the consideration of the science behind vaccine development and distribution is over. In his experience, nothing was ever black and white, open or closed, Schaffner said. "If you start with the fundamental of science, then you can debate the issues of public policy based on that foundation." There isn't a single way to do things. There are always options and choices.

Having been at the table for many of those debates, Schaffner said, they "have been rich and very very appropriate. The foundation of science in the new iteration of the ACIP is uncertain at best."

In the short video above, Schaffner talks more about his concern for future recommendations to come from the largely unvetted group of replacement ACIP members appointed in June, a number of who bring well recognized bias against vaccines and immunization to that table.

The following transcript has been lightly edited for style

Patient Care: Getting into some of the specifics from an infectious disease and public health perspective, what are the immediate consequences of the recent dismissal of the CDC’s Advisory Committee on Immunization Practices? And what are your greatest concerns for the impact on public confidence in vaccines?

William Schaffner, MD: Well, the greatest concern is that previously, the Advisory Committee on Immunization Practices—now in its 61st year—has always based its very careful deliberations about who ought to receive which vaccines, and when, on science. If you start with the fundamentals of science, you can then debate issues of public policy based on that science. There’s not just one way to do things; you have options. And those debates have been rich and very appropriate over many years.

This foundation of science, in the new iteration of the ACIP, is uncertain at best. Many believe it’s simply no longer there, and that recommendations may now be made on the basis of bias, or a social or even political point of view. So there’s a great deal of concern about the standing of the ACIP going forward, and all the implications that has—not least of which is public confidence in vaccines. If we begin to see ACIP recommendations that are at variance with those from an array of professional societies, that will create confusion among providers, for starters, and clearly also for the public.

William Schaffner, MD, is professor of preventive medicine with a primary appointment in the department of health policy and a professor of medicine in the division of infectious diseases at the Vanderbilt University School of Medicine, in Nashville, TN. Schaffner is the current medical director and past president of the National Foundation for Infectious Diseases and has served on the Executive Board for the Infectious Diseases Society of America.

For more of our conversation with Dr Schaffner, see:

What's the Mood Among Infectious Disease Experts Right Now? We Asked William Schaffner, MD

How Would You Advise An Infectious Disease Resident About a Career Path Today? This Expert Isn't Sure