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Featured topic and speakers
Are vaccines safe? How long have vaccines been around? What is ACIP? Is there a booster for RSV? How old is the measles vaccine? What happens at ACIP meetings?
What are the latest vaccine recommendations? Sandra Fryhofer, MD, AMA’s liaison to the Advisory Committee on Immunization Practices (ACIP), shares news from the most recent meeting. AMA Chief Experience Officer Todd Unger hosts.
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Speaker
- Sandra Fryhofer, MD, AMA’s liaison, Advisory Committee on Immunization Practices (ACIP); board member, AMA Board of Trustees
Transcript
Dr. Fryhofer: I have to tell you, I've been a liaison to ACIP for nearly two decades, and I'm so impressed and reassured by the multiple ways CDC and FDA work together to monitor vaccine safety.
Unger: Hello and welcome to the AMA Update video and podcast. After postponing a meeting in February, the CDC's Advisory Committee on Immunization Practices, or ACIP, recently met for two days and voted in favor of new recommendations for three vaccines. And here with us today to share all those details is the AMA's liaison to the ACIP, Dr. Sandra Fryhofer in Atlanta. I'm Todd Unger, AMA's chief experience officer in Chicago. Dr. Fryhofer, it's so good to have you back.
Dr. Fryhofer: Well, thanks for having me back, Todd.
Unger: Well, I want to begin with some logistics. As I mentioned, this meeting was originally set for February, and then it was postponed. But there was a little confusion about when and if this particular meeting would occur. Can you give us a little bit of background there?
Dr. Fryhofer: Sure. The dates of these public meetings are usually set years in advance, and physicians and public health people from all over the country and the world look forward to them. So when the ACIP's three-day meeting, which was set for the end of February, was suddenly canceled, it was quite concerning. After all, this would have been the first ACIP meeting under this new administration and with the new HHS director.
Mr. Kennedy's previous views and actions have been somewhat anti-vaccine, which made it even a little more concerning. And needless to say, the scientific community was sort of up in arms. In fact, AMA, along with a bunch of other organizations, signed on to a letter to preserve the ACIP meeting, and it worked.
The February meeting was rescheduled to April. The formerly scheduled three-day meeting was compressed into two very full days. There were only three votes. A previously scheduled vote on flu vaccination was not included.
Unger: All right. Now you've been an ACIP liaison for almost 20 years. Was there anything about this particular meeting that was new or different? I heard there was a new orientation, for one.
Dr. Fryhofer: Yes. This was the first time we'd ever had an orientation meeting for liaisons, but it was a really good idea, especially for people that were new to being a liaison. They had it the day before the meeting started and it level-set expectations. They talked about the history of ACIP, how it was established in 1964 and was designated a federal advisory committee in 1972.
Its role is to provide advice and guidance to the CDC director on the most effective means to prevent vaccine-preventable diseases. They also explained the evidence-based process ACIP uses in making its vaccine recommendations. It's called the "evidence to recommendations" framework, or ETR.
At the orientation meeting, they also said that the people that usually help with the broadcast had been let go and warned there could be some technical difficulties. And I thought, oh no. But the remaining staff was able to pull it off with only a few minor technical problems.
It was a really good meeting. And Dr. Melinda Wharton, who is ACIP's executive secretary, and Stephanie Thomas, ACIP's committee management specialist, are really amazing. We also heard some great presentations from CDC staff and others.
Unger: Now I think there was some concern about maybe public comment being eliminated. What happened there?
Dr. Fryhofer: Well, we've always had time for oral public comment at these meetings. Members of the public could also submit written public comments, as well. There was concern that this public comment could be eliminated and here's why.
Back in February, HHS posted in the Federal Register plans to end public comment on agency actions. This essentially would eliminate public participation and comment in public policy proposals and decisions. And the policy of soliciting public comment and feedback on proposals had been business as usual since 1971. This is when former Health Secretary Richardson began this practice. It's now referred to as the Richardson Waiver.
Now, prior to the Richardson Waiver, this type of public input had been previously excluded under the Administrative Procedure Act. Patient advocacy groups issued a sign-on letter opposing this decision, and fortunately, public comment was allowed at this meeting, and it was very informative. Public comment is important. People need to have a way to voice their opinions and be heard.
Unger: Now there's a new CDC director. Was she involved in the meeting?
Dr. Fryhofer: Well, oftentimes at the first ACIP meeting of the year, we hear from the CDC director, particularly when the director is new. And I was disappointed we did not. But then I realized that the new director, Dr. Susan Monarez, has been named but not yet confirmed. And she's actually the first CDC director to have to go through Senate confirmation.
But effective January 23, 2025, she was made both principal deputy CDC director and acting CDC director. But since she hasn't been confirmed by the Senate, I guess things are sort of in limbo right now. But Dr. Monarez holds a PhD in both microbiology and immunology. She's a health scientist with more than 20 years of experience in health innovation, but she's not an MD. I'm looking forward to hearing from her, to meeting with her and working with her.
Unger: Was there anything else different about the meeting?
Dr. Fryhofer: Yes. Usually on the second day of the meeting, we hear reports from agencies like CDC, CMS, FDA, HRSA, NIH, as well as IHS, the Indian Health Service, and OIDP, the Office of Infectious Disease, HIV/AIDS policy. They're usually really interesting and forward-thinking, and it's always been a chance to hear what these agencies were doing in the vaccine space.
Well, that didn't happen at this meeting and it was quite disappointing. But who knows who's left after all the DOGE-directed cuts over just the last few weeks? I'm just so glad we got through this meeting. There were some important votes and there's a lot to be done at our upcoming meeting in June.
Unger: Well, let's get into some of the details around the vaccine votes for this meeting. You said there were three vaccine categories, meningococcal disease, RSV vaccines for adults, and yes, I'm going to say it right, chikungunya vaccines. Dr. Fryhofer, what's new for meningococcal vaccines?
Dr. Fryhofer: There's a new MenABCY combo vaccine. GSK's new pentavalent meningococcal vaccine MenABCWY, brand name PENMENVY, was added as an option when patients need both MenACWY, and MenB vaccines at the same visit. This new GSK vaccine had been FDA approved back in February.
Pfizer also has a pentavalent version. Both are a combo of MenACWY and MenB vaccines. Now, you might remember that the MenACWY components are interchangeable, but the same type of MenB has to be used for all doses in the series and for booster doses as well. This vaccine was also added to the Vaccine for Children's Program by ACIP.
Unger: All right. And now let's turn to RSV vaccines. Does everyone 75 and older still need a dose?
Dr. Fryhofer: Yes, everyone age 75 and older should get a dose of the RSV vaccine. That didn't change, but the age range for the risk-based recommendation for those at high risk of severe RSV disease did, and was lowered from age 60 down to age 50. The medical conditions that increase risk of severe RSV include chronic heart, lung, kidney and liver disease, as well as chronic hematologic and neurologic conditions, and also being frail.
Now understand that lowering the age indication to 50 increases equity, and this is because studies show Black patients are more likely to have more chronic medical conditions at an earlier age, as compared to white patients. We now have three RSV vaccines, but right now only two of them, the two protein-based RSV vaccines, AREXVY and ABRYSVO, are licensed for adults age 50 and older. Moderna's mRESVIA has applied to FDA to lower its age range indication, and that should be decided by June. And the workgroup's now looking at giving RSV vaccine to even younger adults. So more to come, maybe soon.
Unger: What about boosters for RSV? Is there an update there.
Dr. Fryhofer: They're still under study. For now, only one lifetime dose is recommended, but that will likely change. But no new recommendations yet.
Unger: All right. Now for chikungunya vaccines. What's the news there? This is more of a risk, I think, for travelers, isn't it?
Dr. Fryhofer: Exactly. And you did a great job pronouncing that, Todd. I hope I can do it as well as you did. A second type of chikungunya vaccine, Chik-VLP, a virus-like particle vaccine, brand name Vimkunya, was added as an option for adolescents and adults age 12 and older, traveling to areas with active outbreaks of this mosquito-borne illness and also for laboratory workers at increased risk of exposure. Also, a new precaution for those aged 65 and older was added for the other chikungunya vaccine, Chik-LA, a live attenuated virus vaccine, brand name IXCHIQ. This precaution was based on post-licensing surveillance safety studies.
And I have to tell you, I've been a liaison to ACIP for nearly two decades, and I'm so impressed and reassured by the multiple ways CDC and FDA work together to monitor vaccine safety. This includes programs like VAERS, CDC'S Vaccine Adverse Event Reporting System, V-safe, VSD, the Vaccine Safety Datalink, and CISA, the Clinical Immunization Safety Assessment project. They also collaborate with government and non-government partners to ensure vaccine safety.
And I am hoping that once Mr. Kennedy can take a breath and really has time to get a grasp of how these safety monitoring systems work, he'll have confidence, more confidence in the current system. Now, we have to remember, he's not a physician. But in his current position, he is going to learn a lot about the intricacies of vaccine development and the rigorous testing these vaccines go through before coming to market.
Unger: All right. Well, Dr. Fryhofer, we've talked about the votes, but are there any other items of interest that you want to share? Was there a measles update, for instance?
Dr. Fryhofer: Yes. And of all infectious diseases, measles is one of the most contagious. And if you're exposed and you're not immune, 90% of the time, you'll get it too.
But you don't have to because there's a vaccine. We've had one since 1963. It's safe, it's effective and it works. Two doses of MMR, the measles, mumps, rubella vaccine are about 97% effective at preventing measles. One dose is about 93% effective.
Now the discussion at ACIP showed lots of maps with outbreaks and vaccine coverage comparisons. You need 95% coverage of vaccination to provide herd immunity. And in Gaines County, Texas—and that's where the most recent outbreak started and is where it's most concentrated—two MMR dose coverage is only 82%. This outbreak is spreading, and now half of our states are now reporting cases of measles. Two children in Texas who had no previous underlying medical conditions and one adult in New Mexico have died. None of them have been vaccinated.
Our representatives from the CDC have been deployed to Texas. But understand, it's only April, and we've already surpassed last year's 2024 total of 285 measles cases in the U.S. And as per the CDC website, as of April 17, 2025, a total of 800 confirmed measles cases were reported, and that doesn't include those that are measles cases that have not been confirmed.
And Todd, as you know, HHS Secretary Kennedy initially downplayed the outbreak and endorsed taking vitamin A and cod liver oil. Those don't prevent and won't stop this outbreak. Vaccination will. That was not discussed at ACIP, but please know that organized medicine has stepped up in promoting vaccination. And in early March, our AMA President, Dr. Scott, weighed in with an official statement about the importance of MMR vaccination and urging individuals to get vaccinated against the measles, if not already immune.
Unger: It sounds like a lot was discussed in this meeting. Now we can look forward to the next one in June. What are going to be the key topics there?
Dr. Fryhofer: Well, here's a preview. Possible narrowing of COVID vaccination recommendations, possible new changes for HPV and RSV and mpox vaccines, a new monoclonal antibody to prevent RSV in infants, as well as updates on new candidate vaccines for Lyme disease and CMV, cytomegalovirus. And we can only hope this June ACIP meeting happens on time and as scheduled.
Unger: Any final thoughts before we break for today?
Dr. Fryhofer: The first ACIP meeting of the new year is usually paired with the major launch of the new immunization schedules. The Annals of Internal Medicine, as usual, did publish the 2025 adult schedule. And as usual, it also had an accompanying editorial. And I've written some of these in the past.
The author of this one, however, was the annals editor in chief, Dr. Christine Laine. And in this editorial, she reminds us that vaccines have been used in this country for more than two centuries. They go all the way back to President Thomas Jefferson's early adoption of the smallpox inoculation.
Right now, we're facing a lot of vaccine hesitancy and misinformation. The title of her editorial is an important reminder. Our founding fathers recognized the benefit of immunization. We need that same recognition today.
Unger: Well, thank you so much, Dr. Fryhofer, for being here today and sharing what we need to know about vaccines right now. That wraps up today's episode. To support important public health information like this, become an AMA member at ama-assn.org/joinnow.
We'll be back soon with another AMA Update. In the meantime, you can find all our videos and podcasts at ama-assn.org/podcasts. Thanks for joining us today. Please take care.
Disclaimer: The viewpoints expressed in this video are those of the participants and/or do not necessarily reflect the views and policies of the AMA.
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