The U.S. heads toward a patchwork approach to health policy
As a federal panel changes recommendations on hepatitis B vaccinations, concerns rise about whether scientific evidence is being pushed to the side.
The U.S. continues to fall into disarray in crafting health policies, with the end result likely to be a country with a patchwork quilt of practice and guidance.
The latest upheaval in health policy came last week, when the Advisory Committee on Immunization Practices voted to eliminate recommendations for hepatitis B shots soon after birth for most newborns. The panel advises the Centers for Disease Control and Prevention on vaccination recommendations.
The ACIP, stacked with nominees from HHS Secretary Robert Kennedy Jr., voted 8-3 to exclude recommendations for vaccinating newborns. Joseph Hibbeln, a member of ACIP, said the vote to axe a recommendation that every newborn get the hepatitis B vaccine “wasn’t based on data.”
The series of shots have proven almost universally effective in nearly eliminating hepatitis B. Experts say the initial shot is crucial in protecting vulnerable newborns from infection from others with whom they may come into contact who may be carrying the virus. In its vote, the panel says it affirms that the choice of the newborn vaccine should not be required but can be administered after discussion between parents and their clinicians.
In another instance, the Food and Drug Administration changed its recommendations for who should get the COVID-19 vaccine, a shift from previous guidance that supported broader availability of the vaccination.
The controversial decisions – and the recent appointment of vaccine critic Ralph Lee Abraham, MD, as the CDC’s principal deputy director – have further eroded trust in federal agencies as sources of verifiable health information.
Turning elsewhere
More than a few healthcare experts say federal information on controversial topics should be dismissed.
Potential problems were anticipated earlier this year, as the Trump administration named Kennedy, long known for a variety of controversial health views, and other atypical choices for leading positions in the Centers for Medicare & Medicaid Services, the Food and Drug Administration and as surgeon general.
In particular, Kennedy’s approach has crippled confidence in the CDC. For example, Katelyn Jetelina, a popular writer and epidemiologist, has concluded that, “At this time, I suggest the general public avoid the CDC website. If you do go to the CDC website, avoid anything on vaccines, reproductive health, environmental science or health equity.” For example, she says HHS pressured the CDC to publish “scientifically false claims about vaccines and autism ... no new data was presented. This was political actors overriding science in a place where accuracy, integrity, credibility, transparency and honesty literally saves lives.”
She’s not alone. Paul Offit, MD, an infection disease specialist at Children’s Hospital of Philadelphia says the CDC has devolved into “a propaganda machine for RFK Jr.'s fixed, immutable, science-resistant theories. (It’s) being weaponized to promote RFK Jr.’s anti-vaccine point of view. So why should you trust it?”
This sets up a dilemma for public health experts, says Jay Varma, MD, a physician and epidemiologist who’s an expert in the prevention and control of infectious diseases. “The dilemma for outside public health experts is whether to try to preserve public trust in the CDC (and therefore, in the long run, its ability to recover) or to strip away its legitimacy to prevent the public from being misled.” Totally discrediting health agencies completely, in some respects, appears to feed into the current administration’s efforts to negate the value of the government’s role.
Pushback to federal guidance
Increasingly, professional groups are offering alternative guidance, contending that they are better positioned to provide science- and evidence-based information.
The American Academy of Pediatrics, the Infectious Diseases Society of America, the American College of Obstetricians and Gynecologists, the American College of Physicians and the Center for Infectious Disease Research and Policy are pushing back. The organizations say they support alternative vaccine guidance from the American Academy of Pediatrics, which includes continuing to provide the hepatitis B vaccine to newborns soon after birth.
Also, some states and regions continue to challenge the CDC’s guidance on health, while others hew to the line that the agency is setting out, with some even going beyond. To no one’s surprise, the difference is not medical, but political.
In one example, health officials from 10 Northeastern states are forming the Northeast Public Health Collaborative to issue vaccine guidance and coordinate public health efforts, which is likely to conflict with pronouncements from the CDC. The group said it would work on vaccine recommendations, data collection and emergency preparedness, among other health efforts.
A similar initiative is emerging in the Pacific Northwest, where Democratic governors from California, Oregon and Washington say they are creating an alliance to “safeguard health policies,” promising to base recommendations from national medical organizations.
In Illinois, Gov. J.B. Pritzker is promoting an alternative path to the CDC, in early December signing a bill to protect and expand vaccine access for state residents. “It is vitally important that Illinois families can get trusted advice about vaccines, guided by experts and established research,” Pritzker said. “With this new law, we will be able to respond swiftly to any dangerous or anti-science actions at the federal level — and ensure Illinoisans stay protected.”
By contrast, state leaders in Florida are taking steps to phase out all childhood vaccine mandates in the state, modeling a state-level “Make America Healthy Again” commission modeled after similar initiatives at the federal level. State Surgeon General Joseph Ladapo, MD, likened vaccination requirements as similar to “slavery,” hampering parents’ options for making health decisions about their children.
The result is likely to be that the country will be inconsistent in overarching policies, with some states following one set of rules while others ease back and leave more choice to individuals or families. But experts worry that diseases are not respecters of borders, and lax approaches in some states could cross state lines and cause widespread health issues.
For example, measles outbreaks recently were reported in South Carolina and the Utah-Arizona border, with the number of measles outbreaks rising to 47 this year, the CDC notes. Nationally, 2,000 cases have been reported for a disease that had been considered eliminated since 2000.
In another outbreak, three infants have died in Kentucky because of whooping cough, with some 566 cases reported in the state this year. Nationally, more than 25,000 cases of whooping cough have been reported so far this year, down slightly from 33,000 cases reported in the same time period last year. Falling vaccination rates are being blamed for the increase.
With the clash of opinion on verified medical information, trusted health organizations and professionals will need to fill the gap, says Varma. “Defend the professionalism of CDC scientists and affirm the real science that still exists. Criticize decisions that are dictated primarily by politics,” he says. “Make clear that this is not just about science but about democracy itself.”
Fred Bazzoli is Editor in Chief of Health Data Management.