The Advisory Committee on Immunization Practices (ACIP) is a federal advisory committee that develops recommendations for vaccination in the United States. The Centers for Disease Control and Prevention (CDC) bases their recommendations for adult and childhood vaccines on the ACIP recommendations.
In the last few weeks, you may have seen some headlines and social media posts questioning the role of the ACIP and their influence on vaccine policy in the United States. The Secretary of the Department of Health and Human Services has alleged severe conflicts of interest by members of this committee and is reportedly considering removing participants. Just what is the ACIP and why are they so important to protect health?
The Advisory Committee on Immunization Practices [archived link] (ACIP) is a federal advisory committee that has been around for more than 50 years and develops recommendations for vaccination in the United States. These recommendations include who should get which vaccine, when should those vaccines be given, what special circumstances might change the routine vaccination schedule, and what contraindications or safety concerns should be considered. The Centers for Disease Control and Prevention (CDC) bases their recommendations [archived link] for adult and childhood vaccines on the ACIP recommendations. The ACIP also helps determine which vaccines are covered by insurance and the Vaccines for Children Program [archived link], which provides free vaccines to children whose parents and guardians cannot afford vaccination. Lastly, the group serves as a watchdog, regularly monitoring data to continue to ensure that vaccines are safe and effective. This group is incredibly important in guiding public health and vaccination programs in the United States.
The current administration is making claims that the ACIP is filled with members who are unqualified or have severe conflicts of interest, harming the work of the committee and potentially threatening the health of the US population. Fortunately, this just isn’t the case. There are 19 voting members of the ACIP who represent a broad group of people with expertise in vaccinology, immunology, family medicine, pediatrics, internal medicine, public health, and other healthcare fields. One member represents consumers and provides critical insight into the perspective of patients and community members. Each member serves a 4-year term. Prior to selection, members are heavily vetted by the ACIP Steering Committee and then chosen by the Secretary of Health and Human Services. Members must disclose any potential conflicts of interest, and recuse themselves from discussions or votes if any conflicts raise a concern for their ability to impartially evaluate the data to make appropriate recommendations. It is important to note that ACIP members are volunteers! They are not paid for their work and only receive reimbursement for expenses to attend meetings.
The ACIP also uses subgroups, known as work groups [archived link], to review relevant published and unpublished data to develop recommendation options to present to the ACIP. Work groups focus on specific vaccines, like influenza or pneumococcal, and meet regularly to propose updates to recommendations based on the latest and highest quality evidence. Members of work groups are also volunteers, highly vetted, and required to disclose any potential conflict of interest. This Nerdy Girl, for example, has been serving on an ACIP work group for years. I can attest I haven’t made one cent from participating and do not have any pharmaceutical or other conflicts of interest.
Recommendations made by the ACIP work groups and committees are made using a strict methodology. Prior to meetings, ACIP members carefully review all available data for each vaccine being discussed at that meeting. This data includes information on safety, effectiveness, harms, and age and disease-specific considerations. The ACIP uses a framework called “GRADE” [archived link] to help use the presented data to make recommendations. GRADE stands for Grading Recommendations, Assessment, Development, and Evaluation. Using this transparent and standardized framework, the ACIP considers all the scientific evidence as well as evidence and public comment regarding the extent of the public health risk posed by the disease, values of the people affected, acceptability, feasibility, resource use, economic analysis, and equity. These discussions can be long and detailed and are open to the public.
Once the ACIP makes a recommendation, the CDC director can approve, amend, or reject the recommendation. This is then published in the CDC Morbidity and Mortality Weekly Report [archived link] and becomes the official recommendation in the United States. Healthcare providers and public health agencies can then start to implement these recommendations.
This video does a great job of explaining the ACIP and their processes.
The ACIP functions as an independent advisory group, composed of members who do not work for the CDC. It was designed this way in part to ensure that recommendations are based solely on scientific evidence and to reduce direct influence from the agency. The goal is to have unbiased decision-making on vaccine usage in the United States to promote public and individual health.
In short, the ACIP is a critical group to provide vaccine recommendations based on science and not political ideology. The ACIP uses rigorous methodology to reduce conflict of interest and recuse members if a conflict arises and to use the best available evidence to make recommendations for vaccination.
