RFK Jr. may upend how vaccine recommendations are categorized - Ars Technica

Overview

RFK Jr. may upend how vaccine recommendations are categorized

There are currently 3 categories. Without reason, RFK Jr. is considering changes.

Details

Under anti-vaccine Health Secretary Robert F. Kennedy Jr., the US health department is considering changing how vaccine recommendations are categorized and described. The move creates the possibility that vaccinations currently considered “routine” or “universal” could be given new designations that sound less definitive or more conditional, such as “recommended with qualification” or recommended based on “shared clinical decision-making.”

Kennedy has made no new rules or recommendations for the categories yet. However, he laid out ideas and possibilities in a Request for Information (RFI) posted online Friday and published in the Federal Register on Monday. In the 10-page document, Kennedy poses questions about the current categories and asks the public to weigh in on ideas for how to change or replace them. The deadline to comment on the questions and ideas is September 20.

Currently, there are three categories of vaccination recommendations granted by the Centers for Disease Control and Prevention, which is informed by a panel of independent expert advisors, the Advisory Committee on Immunization Practices (ACIP). The three categories are: routine, otherwise considered universal (a recommendation that everyone should get a vaccine); risk-based recommendations (only certain groups at higher risk should get a vaccine); and recommendations based on “shared clinical decision-making,” or SCDM (a flexible but uncommon recommendation for vaccination based on the characteristics, values, and preferences of a patient and the judgment of their healthcare provider).

Before Kennedy’s oversight, the CDC and ACIP used an evidence-based decision-making framework to determine which type of recommendation to give a vaccination. There is no clear, evidence-based reason to question the current categories, nor any evidence to support changing to the new categories Kennedy proposes. In his RFI, Kennedy prefaces his efforts only by citing an executive order on vaccines that Trump signed two weeks ago that aimed to slash and overhaul federal vaccine recommendations.

The order and the new RFI are part of a larger, relentless effort from Kennedy and Trump to undermine federal vaccine recommendations and prop up the false and thoroughly debunked claim that vaccines are linked to autism. Kennedy previously tried to unilaterally slash the CDC’s childhood vaccine recommendations, matching them to those of Denmark—a relatively tiny, homogenous country with universal healthcare that recommends fewer vaccines than any other high-income country. Kennedy also fired all 17 experts on ACIP and repopulated the panel with hand-selected allies who share his anti-vaccine beliefs. Last year, the panel also made several unwarranted changes to vaccine recommendations, including dropping the universal recommendation for a birth dose of the hepatitis B vaccine—a move widely decried by medical and health experts.

For now, a federal judge has temporarily blocked Kennedy’s changes to federal vaccine recommendations, most of his ACIP appointments, and changes made by his ACIP  amid a lawsuit led by the American Academy of Pediatrics. The judge ruled in March that Kennedy’s vaccine changes and ACIP appointments were likely illegal and done without proper procedure.

The RFI appears to be part of an effort to follow administrative procedures, which often include public comment periods. But it also offers more insight into Kennedy’s next direction for his anti-vaccine efforts.

In an announcement Friday, Kennedy’s Department of Health and Human Services summarized the RFI as part of an effort “examining whether the current recommendation framework appropriately reflects the strength of the evidence, accounts for individual circumstances and values, and supports informed discussions among patients, parents, and healthcare providers.”

More specifically, the RFI asks the public to consider whether vaccine recommendations should be made with a “presumption in favor of individual autonomy and religious freedom.” It also seeks input on how to handle recommendations when “randomized controlled trial evidence is absent, infeasible, or unethical to obtain.” This relates to a common attack Kennedy has made against childhood vaccines, in which he claims their safety and efficacy trials are flawed because they didn’t test the vaccines against an inert placebo. Scientific and medical experts have largely dismissed this attack, noting that such trials are unnecessary, in many cases unethical, and in some cases the claim is just false. But it seems Kennedy may use it to justify making vaccine recommendations sound less definitive.

As for what the new recommendation categories might be, the RFI gives special consideration to SCDM, which is currently used rarely. The Meningococcal B Vaccination is one of the few vaccines with an SCDM recommendation. The RFI describes this type of recommendation as an “intermediate category” that “provides no default” choice on a vaccination, avoiding a “binary choice between a universal recommendation and no recommendation at all.”

“This allows for an additional opportunity between patient and provider to discuss the state of the evidence and gives weight to the values and preferences of patients and parents/guardians, including considerations of personal autonomy, informed consent, and religious conviction,” the RFI reads. But it also notes that SCDM, when used, has raised confusion. The RFI asks the public to weigh in on potential future use.

Otherwise, the RFI asks for other category options, providing a few ideas, including “recommended, but not during infancy,” “recommended with qualification,” or “shared clinical decision-making with qualification.” The document does not elaborate on what any of those categories might mean.

1.          Due to need for "absolute success," China delays critical Moon launch to 2027
   

2.          Putting mice into hibernation causes a major loss of synapses
   

3.          Review: Chuwi's $449 Unibook laptop is a funhouse-mirror Mac Book Neo
   

4.          Nvidia senior manager linked to Supermicro scheme smuggling AI servers to China
   

5.          Trump tried to curb clean energy. It’s booming anyway.
   

Ars Technica has been separating the signal from the noise for over 25 years. With our unique combination of technical savvy and wide-ranging interest in the technological arts and sciences, Ars is the trusted source in a sea of information. After all, you don’t need to know everything, only what’s important.

Key Takeaways

• There are currently 3 categories
• Under anti-vaccine Health Secretary Robert F
• Kennedy has made no new rules or recommendations for the categories yet
• Currently, there are three categories of vaccination recommendations granted by the Centers for Disease Control and Prevention, which is informed by a panel of independent expert advisors, the Advisory Committee on Immunization Practices (ACIP)