The panel of federal vaccine advisors hand-selected by anti-vaccine Health Secretary Robert F. Kennedy Jr. has once again punted on whether to strip recommendations for hepatitis B vaccinations for newborns—a move it tried to make in September before realizing it didn’t know what it was doing. The decision to delay the vote today came abruptly this afternoon when the panel realized it still does not understand the topic or what it was voting on.

Prior to today’s 6–3 vote to delay a decision, there was a swirl of confusion over the wording of what a new recommendation would be. Panel members had gotten three different versions of the proposed recommendation in the 72 hours prior to the meeting, one panelist said. And the meeting’s data presentations this morning offered no clarity on the subject—they were delivered entirely by anti-vaccine activists who have no subject matter expertise and who made a dizzying amount of false and absurd claims.

“Completely inappropriate”

Overall, the meeting was disorganized and farcical. Kennedy’s panel has abandoned the evidence-based framework for setting vaccine policy in favor of airing unvetted presentations with misrepresentations, conspiracy theories, and cherry-picked studies. At times, there were tense exchanges, chaos, confusion, and misunderstandings.

Still, the discussion was watched closely by the medical and health community, which expects that the panel—composed of Kennedy allies who espouse anti-vaccine views—will strip the recommendation for a hepatitis B vaccine birth dose. Decisions by the committee, the Advisory Committee on Immunization Practices (ACIP) in the Centers for Disease Control and Prevention, have historically set national vaccine policy. Health insurance programs are required to cover, at no cost, vaccinations recommended by the ACIP. So rescinding a recommendation means Americans could lose coverage.

Medical and public health experts consider the birth-dose vaccination to be critical for protecting all infants from contracting the highly infectious virus that, when acquired early in life from their mother or anyone else, almost always causes chronic infections that lead to liver disease, cancer, and early death. There is no data suggesting harms from the newborn dose, nor any safety data suggesting that delaying the first dose by a month or two, as ACIP is considering, would be safer or better in any way. But studies do indicate that such a delay would lead to more hepatitis B infections in babies

These points were hard to find in today’s presentations. Abandoning standard protocol, the meeting did not include any presentations or data reviews led by CDC scientists or subject matter experts. Kennedy has also barred medical and health expert liaisons—such as the American Medical Association, the Infectious Disease Society of America, and the American Academy of Pediatrics—from participating in the ACIP working groups, which compile data and set language for proposed vaccine recommendations.

Anti-vaccine presentations

Instead, today, ACIP heard only from anti-vaccine activists. The first was Cynthia Nevison, a climate researcher and anti-vaccine activist with ties to Children’s Health Defense, Kennedy’s anti-vaccine organization. She was also a board member of an advocacy group called Safe Minds, which promotes a false link between autism and vaccines, specifically the mercury-containing vaccine preservative thimerosal, which was removed from routine childhood vaccines in the early 2000s. (Safe Minds stands for Sensible Action For Ending Mercury-Induced Neurological Disorders.) According to her academic research profile at the University of Colorado Boulder, her expertise is in “global biogeochemical cycles of carbon and nitrogen and their impact on atmospheric trace gases.”

Far from that topic, Nevison gave a presentation downplaying the transmission of hepatitis B and the benefits of vaccines. She falsely claimed that the dramatic decline in hepatitis B infections that followed vaccination efforts was not actually due to the vaccination efforts—despite irrefutable evidence that it was. And she followed that up with her own unvetted modeling claiming that CDC scientists overestimate the risk of transmission. She ended by presenting a few studies showing declines in blood antibody levels after initial vaccination, which she claimed suggests that the hepatitis B vaccine does not offer lifelong protection, an incorrect takeaway based on her lack of expertise.

The author of one of the studies just happened to be present at today’s meeting. Pediatrician Amy Middleman, who is an ACIP liaison representing the Society for Adolescent Health and Medicine (SAHM) and a professor at Case Western Reserve University School of Medicine, was the first author on a key study Nevison referenced. Middleman was quick to point out that Nevison had completely misunderstood the study, which actually showed that cell-based immune protection from the vaccine offers robust lifelong protection, even after initial antibody levels decline (called an anamnestic response).

“This is where a really experienced understanding of immunization comes into play,” Middleman said. “The entire point of our study is that for most vaccines, the anamnestic response is really their superpower. So this study showed that memory cells exist such that when they see something that looks like the hepatitis B disease, they actually attack. The presence of a robust and anamnestic response, regardless of circulating antibody years later, shows true protection.”

The next presentation was from Mark Blaxill, an anti-vaccine activist installed at the CDC in September. Blaxill gave a presentation on hepatitis B vaccine safety, despite having no background in medicine or science. He previously worked as an executive for a technology investment firm and, like Nevison, also worked for Safe Minds, where he was vice president. Blaxill has written books and many articles falsely claiming that vaccines cause a variety of harms in children. In 2004, when an Institute of Medicine analysis concluded that there were no convincing links between vaccines and autism, Blaxill publicly protested the result.

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