Who is Up For Some Explosive Statutorily Required Policy Advisory Meeting Action?

Ring in the new year with all of 2025's legally mandated Advisory Commission on Childhood Vaccines meetings in one thrilling afternoon

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Those of you following the ongoing collapse of American public health know that a lot of the action goes down at various advisory committee meetings. The crown jewel of these is the Advisory Committee on Immunization Practices (ACIP), which is currently populated by the crème de la crème of the extended MAHA anti-vax grifter universe.

US Health and Human Services Secretary Robert F. Kennedy, Jr. has successfully stocked ACIP with enough people who are either uncritical yes-men or crazed conspiracy theorists. Both of these groups are also completely inept, far less intellectually insightful than they think they are, and entirely serve Kennedy’s agenda of taking out as many vaccines as humanly possible. So far they have successfully recommended against multi-dose flu vaccines containing thimerosal, the measles-mumps-rubella-varicella (MMRV) combination vaccine, and the birth dose of the hepatitis B vaccine. ACIP recommendations carry significant weight, and their move toward so-called “shared clinical decision making”—which basically means optional—will have profound effects on vaccine uptake.

Although the ACIP has been quite successful in chipping away at herd immunity to preventable diseases, they can’t really do much about one of Kennedy’s most hated institutions supporting vaccination: the Vaccine Injury Compensation Program (VICP), sometimes also called “vaccine court.” The VICP is a no-fault forum for compensating vaccine injury claims.

Kennedy is an attorney and vaccine injury litigation has been extremely lucrative for him. He really, really hates the VICP because it limits damages and liability from big vaccine manufacturers. If the VICP weren’t there, he and his ambulance-chasing comrades in the vaccine injury lawsuit industry would be able to make a lot more money. And if the VICP weren’t there, a lot of vaccine manufacturers would pull out of the market altogether.

One way to get rid of the VICP is to make it go bankrupt. There is about $4 billion in the VICP’s trust for compensating injury claims, which is funded by a $0.75 excise tax on each vaccine. If autism is added to the Vaccine Injury Table (list of eligible vaccine injury claims), it enables an estimated $100 billion in claims. The VICP would go bankrupt overnight.

As the avowed enemy of immunization, this prospect seems to appeal greatly to Kennedy. However, he does not have the authority to just end the VICP. The HHS Secretary is required by law to consult with the Advisory Committee on Childhood Vaccines (ACCV) before making any changes to the Vaccine Injury Table. The ACCV is the ACIP of the VICP (and if you like reading exquisitely crafted prose like that sentence, subscribe to my newsletter).

ACCV votes on recommendations for the VICP. If Kennedy wants to add autism to the Vaccine Injury Table, then he has to go through ACCV to do it. If ACCV voted to recommend that autism is an eligible VICP claim, then goodbye, VICP.

The ACCV is required by law to meet four times per year. They didn’t meet at all this year. So they scheduled all four meetings yesterday. Four 30-minute meetings, back-to-back, for discussion only. Fortunately, the ACCV’s membership has not really changed as far as I can tell, so they did not suddenly reveal themselves to be anti-vax MAHA operatives out to tank the VICP.

Because I live to watch US government immunization advisory meetings on my days off, I watched this yesterday so you don’t have to, since you may have to wait for an online recording to become available. Unlike ACIP, which livestreams its meetings on YouTube, this meeting is on goddamn Microsoft Teams!

Make advisory meetings boring again

The meeting was convened by Rear Admiral Krista Pedley from the Health Resources and Services Administration (HRSA), which is an agency within HHS that oversees VICP. There were multiple presentations on the ACCV and the VICP, including a review of how it works, data on VICP’s performance, scientific and legal standards, and what seemed to me like a pretty honest and objective appraisal of areas that could be improved further, especially regarding the speed at which claims move through the system. I found this extremely useful. Although I know a lot about vaccines, including a lot about vaccine policy, I am not a legal expert, so I appreciated the information.

The rest of the meeting was mostly public comments, which covered a variety of viewpoints. The most commonly repeated one was alarm and frustration that the meetings were announced with such short notice in the Federal Register, since they were clearly scheduled to meet statutory requirements and nothing more. The majority of the comments expressed concerns similar to those in this comment from the Infectious Diseases Society of America (IDSA) and a bunch of other professional societies: due to the hasty scheduling, they are concerned that ACCV will not continue to adhere to established processes going forward and that they will recommend adding autism to the Vaccine Injury Table.

Sincerely, almost 40 professional medical and scientific societies

I strongly doubt that ACCV in its current form would add autism to the Table. All of the people who presented today were serious government scientists or lawyers, who gave straightforward, factual presentations. They presented either background information or evidence. It wasn’t dramatic. None of the ACCV members appeared to have an agenda. They all seem like serious, professional people who are carrying out their duties. It was actually quite boring.

By contrast, ACIP meetings these days are completely wild. Previous meetings have been dominated by the extreme anti-vax contingent demonstrating both their surplus of bad faith and complete dearth of any relevant expertise. Every ACIP meeting is entertaining due to the chaos resulting from their incompetence, as well as their extremely high potential for unhinged misbehavior. An unintentionally hilarious debate over what words mean will be interrupted by Robert Malone popping in like a demented alternate universe conspiracy-addled Papa Smurf to demand agreement with his correlates of protection denialism. The ACIP external liaisons will put the entire panel on blast, and sometimes arguments about Zoom muting and hand raising will ensue. Tracy Beth Høeg will bring her anti-vax disinformation dressed up as an ad for preventable disease tourism in Denmark over from FDA, and there is usually a special anti-vax guest star. At the last meeting, ACIP welcomed vaccine injury lawyer and discount Ali Velshi impersonator Aaron Siri, author of the recent book Vaccines, Amen, to rail untruthfully about the VICP and virtually every childhood vaccine on the schedule for 90 minutes. Someone gets caught on a hot mic at least once a meeting. Last time, ACIP Chair Kirk Milhoan called in from an airport lounge and was caught telling Cody Meissner that he felt like the panelists were “puppets on a string” rather than independent experts. At the meeting before that one, someone called Retsef Levi an idiot. Something unexpected is always likely to keep ACIP meetings lively.

Watching the ACIP clown car roll into Atlanta once a trimester is usually a stressful experience. It’s like binge-watching an entire season of Secret Lives of Mormon Wives—by the time you get to the climax of the most dirty soda-addled, reproductively active, terrifyingly regressive sober people on the planet backstabbing each other over Instagram sponsorship deals, you are exhausted and pray you never hear anything about the founding moral values of MomTok ever again. That is in spite of how thoroughly entertained I was when Miranda—a former principal in a Mormon TikTok influencer swinger scandal—consoled her ex-husband’s new girlfriend because he got into a fight with the baby daddy of the woman he cheated on Miranda with, all while wearing lobster claws at her bubbly water-sponsored Halloween party.

Keep this out of immunization advisory meetings

No such silliness was evident at the ACCV meeting. It was pretty uneventful. That seems encouraging and it is, for now. But time will tell if it will stay that way.

If you want vaccines, you must have VICP

The VICP and the ACCV were established by the National Childhood Vaccine Injury Act (NCVIA) in 1986, because vaccine manufacturers were going to stop making vaccines due to safety issues with the pertussis component of the diphtheria-pertussis-tetanus (DPT) vaccine. The legal costs were too oppressive, and childhood vaccines are not profitable products to manufacture. People only get them a couple times in their lives at most. Contrary to what anti-vaxxers will tell you, they don’t make big money for pharmaceutical companies.

There is a reason why GSK advertises Shingrix (vaccine for preventing shingles in adults) but Merck does not market VariVax (vaccine for preventing chickenpox in kids). There is a huge market for Shingrix, but many don’t know they might benefit from it, and it’s covered by Medicare. Shingrix provides significant benefits, in that it greatly reduces the risk of shingles in older people who already had chickenpox. However, this benefit is largely confined to those people. When people are infected with varicella-zoster virus (VZV), they get varicella (chicken pox). Like all herpesviruses, VZV can establish latency. Its stable DNA genome can basically hang out for decades in the neurons of the dorsal root ganglia, a nerve bundle at the base of the spine. The infection can be reactivated by stress, aging, nutrition, co-infection, lack of sleep, or any other number of poorly understood triggers. VZV reactivation causes herpes zoster (shingles), which is usually much more painful than the original chicken pox. Shingles can be extremely severe and can kill people. Boosting existing immunity against VZV with Shingrix decreases the likelihood that the latent infection will reactivate. Shingrix works great for preventing shingles, but it doesn’t clear the latent VZV infection, so people may need boosters.

Shingrix does not benefit people who have never had VZV if they received Varivax, because the varicella vaccine, whether alone or in combination with the measles-mumps-rubella (MMR) vaccine, prevents VZV from establishing latency in the first place. People immunized with two doses of Varivax on the childhood schedule will never get chickenpox, so they will never get shingles. GSK focuses its own on raising awareness in the untapped adult market that might benefit from Shingrix and can produce a meaningful return for the corporation. Merck focuses its resources to advertise other products to more lucrative markets beside the unchanging two-time pool of children who automatically get Varivax. Both companies are able to make vaccines and profit, as vaccine manufacturers must do, being businesses in a capitalist economy. Older people benefit from a vaccine that reduces their risk of a painful and life-threatening disease, and children still get vaccines that spare them from facing the same fate decades down the road.

Some vaccines can be profitable, but the stalwarts of the vaccine schedule, like the MMR, are not. The government does not manufacture vaccines. They rely on pharmaceutical companies with the facilities and expertise required to do it. Pharmaceutical companies are businesses that need to make money to sustain the business. If the government considers it a public benefit to immunize its population, then it needs to subsidize it.

One way of subsidizing vaccines is to incentivize manufacturers to make them, so there is a steady, affordable supply, by ensuring they are protected from catastrophic liability. Although the benefits of vaccination demonstrably outweigh the risks, vaccines injuries can and do occur very infrequently, so manufacturers can never eliminate this risk completely. You can’t cure unexpected anaphylaxis, undetected immune deficiencies, or undiagnosed genetic disorders that increase the risk of a vaccine injury. And if the cost of litigation drives up the cost of making a vaccine to the point that the manufacturer’s solvency is at risk, that manufacturer might stop making that vaccine.

The NCVIA was passed because manufacturers were going to pull out of the market altogether to avoid more potentially business-destroying pertussis vaccine injury claims. By creating the VICP, the NCVIA incentivized Merck, GSK, and Sanofi (manufacturers of most of the childhood vaccines on the schedule) to accept the liability and lack of windfall profits that comes with making these essential medicines.

Vaccine injuries are rare, but they do happen and we can’t eliminate them. Having a no-fault injury compensation program like VICP is necessary to make sure that everyone is supported: people who are injured can get fair restitution and vaccine manufacturing remains commercially viable.

VICP squad

While the VICP remains intact for now, Kennedy hasn’t exactly been discreet about his intentions for it. He has repeatedly stated his intention to “fix” it. I am always deeply suspicious of people with no other qualifications besides unearned confidence who claim they can “fix” something that might need some work, but isn’t irreparably broken. If you aren’t a licensed and bonded plumber, then I don’t want to hear any of your empty assurances about fixing my clogged toilet.

Kennedy hates vaccines, so I have a pretty good idea what he means by “fixing” the vaccine court. He means demolition. But stripping the VICP for parts will fix very little besides appeasing Kennedy’s personal yearning for mass death from vaccine-preventable disease. Retaining a functioning VICP is absolutely critical to ensuring continued vaccine access for millions of children.

Because it was the result of the NCVIA and is bound by its statutory constraints, Kennedy cannot just remake the VICP to suit his vision. He cannot just change the Vaccine Injury Table or close down the VICP. He has to have four ACCV meetings per year. He is limited by the law, much more so than in other parts of HHS where he has more unilateral authority. However, he could give the ACCV the old ACIP treatment and replace the current members with those who would be more likely to follow marching orders. Since the ACCV can make recommendations to change the Vaccine Injury Table on their own, Kennedy may try to install loyalists who will unquestioningly propose and vote on adding autism to the Table. It will be critical to watch this closely going forward and raise hell if Kennedy decides to ACIP the ACCV.

Correction from Angie: I wrote that Merck makes both Shingrix and Varivax, but I was mistaken. GSK makes Shingrix and Merck makes Varivax and I corrected this. I have a terrible habit of mixing up who makes which childhood vaccine. I also have a terrible editor who really doesn’t do very much of use and was apparently too lazy to fact-check (I am the editor in question). So I am very grateful to the reader who pointed out my error, but had the grace to not mock amateur hour over here at Rasmussen Retorts HQ. They are a highly respected science journalist and would have been justified in doing so. Thank you for catching that, and for your restraint! ❤️

Resources

ACCV Charter. HRSA, 1986.

Gounder. Inside the High-Stakes Battle Over Vaccine Injury Compensation, Autism, and Public Trust. KFF Health News, 2025.

Reiss. Vaccine liability and shared clinical decision making, Skeptical Raptor, 2025. Excellent explainer piece by my colleague Dorit Reiss at UCSF Law on the VICP and many rules and constraints around it.