Citing concerns over Health and Human Services Secretary Robert F. Kennedy Jr.’s replacement of federal vaccine advisors, the American Academy of Pediatrics on Tuesday released its own immunization schedule for infants, children and adolescents.
The AAP describes its recommendations (PDF) on routine immunizations against 18 diseases—including influenza, measles and COVID-19—as a formal continuation of its evidence-based advocacy.
“The AAP will continue to provide recommendations for immunizations that are rooted in science and are in the best interest of the health of infants, children and adolescents,” AAP President Susan J. Kressly, M.D., said in a release. “Pediatricians know how important routine childhood immunizations are in keeping children, families and their communities healthy and thriving.”
The group noted that its recommendations differ somewhat from the Centers for Disease Control and Prevention Advisory Committee on Immunization Practices, a panel of experts that traditionally shapes guidelines on routine vaccinations. In early June, RFK Jr. ousted all 17 members of the ACIP and replaced them with advisors who major medical organizations and public health experts warned had previously expressed inaccurate and anti-vaccine views.
Notably, a meeting of the revamped ACIP held later that month—which was boycotted by the AAP—included a recommendation to remove the long-used preservative thimerosal from flu shots. Anti-vaccine activists have claimed thimerosal, which contains mercury, can cause autism, though multiple studies, including one by the CDC in 2010, have shown that there is no link.
The ACIP has also booted major professional groups like the American Medical Association from its working groups, which prepare evidence for review by the committee. More recent days have seen the restoration of an HHS’s Task Force on Safer Childhood Vaccines, which was disbanded in 1998.
Critics of RFK Jr. have cast these and other moves as a continuation of his crusade against vaccines, during which he has spread falsehoods about their safety and links to autism both before and after taking on the nation’s top health role.
Promising “radical transparency,” the secretary and his supporters have described the country’s public health apparatus and leading medical groups as compromised by industry interests and willing to cover up vaccine-related harm. In a social media post responding to the AAP's release, RFK described the recommendations as a "list of corporate-friendly vaccine recommendations" and highlighted donations exceeding $50,000 the group lists from vaccine makers Merck, Moderna, Pfizer and Sanofi.
"AAP is angry that CDC has eliminated corporate influence in decisions over vaccine recommendations and returned CDC to gold-standard science and evidence-based medicine laser-focused on children’s health," the secretary wrote. He added that recommendations diverging from the CDC's would not be shielded from liability under the Vaccine Injury Act.
Of note, conflicts of interest among members of the ACIP were at a “historic low” at the time of RKF Jr.’s overhaul, according to a peer-reviewed research letter published this week.
The AAP is the country’s largest independent professional association of pediatricians, and was among the several healthcare practitioner groups that loudly condemned RFK Jr.’s actions.
Its new recommendations include updates for Respiratory Syncytial Virus, influenza, COVID-19, meningococcal disease and Human Papilloma Virus, as well as the removal of a hepatitis vaccine.
The group’s immunization schedule was published in its clinical guidebook for infectious diseases prevention and treatment, the AAP Red Book Online. Individual recommendations concerning different diseases have been published online ahead of print in the group’s journal, Pediatrics, with plans for a “parent-friendly” version of the schedule to be published on its consumer-facing HealthyChildren.org webpage.
Aside from questions on its trustworthiness, changes to the ACIP and its vaccine recommendations can affect insurance coverage obligations under private health insurance, Medicaid and Medicare Part D, as well as what is included in the safety net Vaccines for Children program. The AAP wants its immunization recommendations to serve as payers’ guidebook the revamped panel’s recommendations improperly loosen those requirements.
“The AAP urges every insurer to cover all the vaccines that are included in this immunization schedule,” Kressly said. “AAP is committed to working with our partners at the local, state and federal levels to make sure every child, in every community has access to vaccines.”
The AAP isn’t alone in pursuing an alternative to federal immunization advisories. In April the University of Minnesota’s Center for Infectious Disease Research and Policy (CIDRAP) launched the Vaccine Integrity Project, a so-far exploratory effort aiming to develop and disseminate robust evidence for immunization recommendations and clinical considerations for providers. The group has called for information campaigns and tailored education initiatives, and is conducting “contingency planning” with state groups and industry partners focused on maintaining national vaccination infrastructure.
Editor's note: This story was updated after publication with RFK's response.