Science for vaccine policy: Independent review of the September 2025 ACIP processes, deliberations and votes.

BACKGROUND

Since 1964, the Advisory Committee on Immunization Practices (ACIP) has shaped US vaccine policy but recently underwent significant structural and procedural changes affecting recommendation quality. This paper presents analyses of the September 2025 ACIP meeting by former ACIP voting members.

METHODS

We examined ACIP policymaking maturity using a standardized tool for assessing national vaccine advisory groups' development and functionality. We also analyzed evidence presented, processes, and vaccine recommendations.

RESULTS

Between April and September 2025, ACIP's policymaking maturity rating fell from an overall score of 100 % to 58 %. The September meeting had multiple transparency violations, including the exclusion of liaison organizations with medical expertise in vaccine implementation before the meeting. Poorly framed policy questions were followed by a lack of systematic application of standard protocols (e.g., GRADE methodology and Evidence to Recommendations framework). The committee voted to recommend shared clinical decision making for COVID-19 vaccines, to limit access to combined first dose MMRV vaccines, and to postpone voting on removing the birth dose of hepatitis B vaccine. Discussions reflected poor understanding of process, inadequate grasp of science, and a focus on low-quality safety data, excluding well-recognized components and standards for vaccine policy making.

CONCLUSIONS

Four concerns have emerged that limit ACIP's ability to make effective vaccine policy recommendations for the US: 1) removal of choice for previously recommended vaccines, thereby limiting opportunities to improve health, 2) focus on theoretical vaccine harms using low-quality data, 3) loss of vaccine science and clinical practice expertise, and 4) reduced transparency and independence.