Pediatricians, parents, and public health professionals have been anxiously awaiting the first meeting of RFK Jr.’s newly reconstituted vaccine panel. He fired every member of the pre-existing panel. The outcome wasn’t as bad as they feared, nor was it satisfying.

Apoorva Mandavilli of The New York Times reported:

In a meeting that devolved into confusion and near chaos, federal advisers on Thursday voted 8 to 3 against vaccinating children under four years old with a combination shot that protects against measles, mumps, rubella and chickenpox.

The meeting ended without a planned vote on whether newborns should receive the vaccine against hepatitis B, a highly infectious disease that damages the liver, as is currently the standard. That vote was postponed until Friday.

About half of the panel’s members were appointed by Health Secretary Robert F. Kennedy Jr. earlier this week. In a sign of how hastily the committee was put together, many of the members needed explanations of the usual protocol for these meetings, the design of scientific studies, and critical flaws in the data they suggested including.

Many of the panelists also seemed unsure about the purpose of the Vaccines for Children program, which provides free shots to roughly half of all American children. Approving which vaccines the program should cover is a key function of the committee.

The decision to rescind the M.M.R.V. recommendation is unlikely to have widespread consequences. The recommendations for other vaccines given separately to protect against those diseases — the more common practice — remain unchanged.

In a bizarre twist, the members also voted 8 to 1 to have the Vaccines for Children program continue to cover the M.M.R.V. vaccine for children under 4. It was unclear whether the members all understood what they were voting for. Three members abstained altogether, one of them explicitly citing his confusion as the reason.

Still, the vote is likely to have yielded the first of many changes to the official recommendations for routine immunizations. 

In an hourslong discussion, the committee members seemed inclined to restrict the hepatitis B vaccine to newborns whose mothers are known to be infected, and to other babies only after they are at least one month old.

But experts said that doing so would increase the risk to newborns. Many hepatitis B infections in pregnant women are missed, despite a longstanding recommendation to test them routinely. Infected women may also not be identified because of inaccurate results or because of problems reporting or interpreting the results.

“It will be challenging to identify all positive moms, and ensure that a birth dose is available to those infants in hospitals, especially for those who do not receive prenatal care,” said Chari Cohen, president of the Hepatitis B Foundation.

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WHY CHANGING THE HEPATITIS B VACCINE SCHEDULE MATTERS!

Michael Hiltzik of the Los Angeles Times explained why medical experts are opposed to postponing the vaccination for hepatitis B.

Hiltzik wrote a column praising Senator Bill Cassidy for stepping up to the plate and criticizing RFK because it was his one vote that enabled RFK to be confirmed. Senator Cassidy agreed to vote for him after RFK pledged not to change the vaccine schedule, a promise he reneged on.

Hiltzik wrote:

Cassidy closed the hearing by expressing concern that Kennedy’s handpicked vaccine advisory committee, stocked with anti-vaccine activists, was scheduled to meet Thursday, at which it seemed poised to alter the CDC’s recommendations on childhood vaccinations by removing several from the recommended list — a step that horrifies the pediatric and epidemiological communities.

Cassidy’s specific concern was about the hepatitis B vaccine, which the CDC has recommended be given at birth. Republicans on the committee ridiculed that recommendation, because hep B is commonly transmitted sexually, and what baby is having sex? The response from physicians is that babies can contract the disease from their mothers, even if their mothers might not even know they’re carriers.

Cassidy, as it happens, is a liver specialist. “I have seen people die from hepatitis,” he said. “This was my practice for 20 years before I entered politics.”

He continued, “For those who say why should a child be vaccinated for a sexually transmitted disease, at birth the child passes through the birth canal. … That passage through the birth canal makes that child vulnerable to the virus. … If that child is infected at birth, more than 90% of them develop chronic, lifelong infection.” That means a lifelong threat of cirrhosis or other deadly liver conditions.

“Before 1991, as many as 20,000 babies — babies — were infected” per year, Cassidy said. In the first decade, through 2001, after the vaccine was approved for newborns, however, “newborn infections of hepatitis B was reduced by 68%. Now, fewer than 20 babies per year get hepatitis B from their mother. That is an accomplishment to make America healthy again,” Cassidy said, mischievously citing RFK Jr.’s policy mantra.

“We should stand up and salute the people that made that decision,” Cassidy said, “because there are people who would otherwise be dead if those mothers were not given that option to have their child vaccinated.”

So, kudos, Sen. Cassidy, for finally explaining why vaccines are necessary.