People protested staff cuts at the US Centers for Disease Control and Prevention in March.Credit: Elijah Nouvelage/Getty
In the nine months since anti-vaccine activist Robert F. Kennedy Jr stepped in as US health secretary, all eyes have been on the US Centers for Disease Control and Prevention (CDC), an agency tasked with protecting the health of Americans and which Kennedy had referred to before his appointment as a “cesspool of corruption”. In June, members of the Advisory Committee on Immunization Practices (ACIP), an expert panel that makes recommendations on what vaccines should be considered safe and effective for Americans were dismissed and replaced with new advisers, most of whom have expressed anti-vaccine views. As a result, access to vaccines against COVID-19, seasonal influenza and measles, mumps, rubella and varicella, among others, has begun to erode.
Michael Osterholm, an epidemiologist at the University of Minnesota in Minneapolis, understood the threat these changes posed to public health and thought that he might be in a position to try and limit the damage. Osterholm directs the Center for Infectious Disease Research and Policy (CIDRAP), a group focused on providing scientific evidence to inform public-health policy. In April, the centre launched the Vaccine Integrity Project (VIP), an initiative aimed at presenting science-based evidence on vaccine safety and efficacy.
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Its first move was to convene specialists from across the US vaccine ecosystem to explore how a non-governmental group could help. The most pressing issue, they concluded, was to take up part of the work once done by the ACIP. In July, with respiratory-virus season looming, the VIP jumped into a rapid review of the data on seasonal vaccines for influenza, coronavirus and respiratory syncytial virus (RSV) to inform recommendations. And it is now analysing data on the hepatitis B vaccine birth dose, which has been recommended to nearly all infants born in the US since the early 1990s. Even though the strategy has helped to keep hepatitis B under control, the current ACIP has decided to re-examine it.
A spokesperson for the US Department of Health and Human Services (HHS), which oversees the CDC says that “ACIP remains the nation‘s scientific compass for immunization policy”. They add that CDC is not limiting access to vaccines, but “returning decision-making power to the American people.”
CIDRAP has also announced plans to publish health alerts modelled on the CDC’s Morbidity and Mortality Weekly Report (MMWR), a long-running public health-bulletin. The centre’s efforts have attracted former CDC officials, including former director Rochelle Walensky. The moves have led to some speculation that CIDRAP is evolving into a sort of shadow CDC that provides public-health guidance in the vacuum created by the overhaul of ACIP and massive layoffs at the agency. Osterholm dismisses this: “No one could replace the CDC,” he says.
What has the VIP accomplished so far?
We were particularly concerned about the seasonal viral pathogen vaccines — influenza, coronavirus and RSV. So, we launched in early July what some said was an impossible task. We took a protocol-based approach to reviewing those vaccines, similar to what the ACIP would do. And from early July until late October, when the final product was published in the New England Journal of Medicine (NEJM)1, we have been continuing to provide information to medical societies of what would be the scientific basis for them to make vaccine recommendations.
Our next stop right now is a review of hepatitis B vaccine, and we’re really focusing on the importance of the infant first dose.
