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CDC narrowly avoids making COVID-19 vaccine prescription-only

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CDC narrowly avoids making COVID-19 vaccine prescription-only

After a contentious discussion that at times referenced discredited theories, low-quality data and desperate pleas from physicians and patients to rely upon sound science, a key CDC committee opted Friday to weaken its existing recommendations on COVID-19 shots, while punting other vaccine decisions to a later date.

The Advisory Committee on Immunization Practices voted unanimously to pull back its current unequivocal recommendation that all adults get vaccinated against COVID-19 in favor of a process of “shared clinical decision making,” in which patients are encouraged to speak to a doctor, nurse or pharmacist first.

The group came extremely close to recommending that the COVID-19 vaccine be available by prescription only, with a 6-6 vote broken by chair Martin Kulldorff’s “no” vote. The group also postponed a vote on hepatitis B vaccination indefinitely, with some members arguing that a proposal to delay the first dose did not go far enough.

The two-day meeting’s chaotic atmosphere left even many close observers confused about what decisions the group actually made.

“What we’re seeing is what happens when individuals who don’t have a basic understanding about how vaccines are delivered are making these crucial policy decisions for the American public. They don’t know what they’re doing,” Dr. Sean O’Leary, chair of American Academy of Pediatrics’ Committee on Infectious Diseases, said Friday during a news conference over Zoom. “What we are getting from ACIP is confusion.”

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On Thursday, the committee voted that children under the age of four receive the measles, mumps and rubella (MMR) vaccine and the varicella, or chickenpox, vaccine in two separate shots given at the same time, instead of a single dose.

It was a relatively minor change. Many pediatricians already do this in order to reduce the risk of febrile seizures.

But the meeting’s tone and the decisions the committee appeared poised to make profoundly worried many physicians and public health officials.

“The damage isn’t just in today’s specific votes, it’s in legitimizing this framework where these laboratory-based studies and theories based on misrepresented findings are given equal standing with robust population-level safety data,” Dr. Jake Scott, an infectious disease specialist at Stanford University School of Medicine, said Friday. “Now every anti-vax group knows that they can package their claims and scientific-looking slides and cite some weird paper out of context, and then potentially get their concerns mandated into official medical documents.”

The COVID-19 discussion was led by Retsef Levi, a professor of operations management at MIT Sloan and the lone member of the committee with no biomedical or clinical degree.

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He began the discussion by making clear that the committee would take into account anecdotal evidence and unpublished reports in its decision making, together with rigorously researched data.

“We need to leverage all the relevant published and unpublished scientific, clinical and public health data, information and knowledge, including experiences from the field. We are going to focus on personalized risk benefit analysis, and we’re going to very much stay away from the narratives or the statements about ‘safe and effective,’” said Levi, who has stated that mRNA vaccines are deadly and should be pulled from the market. “We don’t believe that these are appropriate or scientific language to talk about the issues related to vaccination.”

At one point, a microphone caught someone in the meeting muttering “idiot” as Levi was talking. It was not clear who the speaker was.

The group voted unanimously to postpone any changes to hepatitis B vaccination. Vaccine skeptics appointed to the committee said that a proposal to delay the first dose by a month didn’t go far enough.

ACIP member Vicky Pebsworth, a nurse who serves as research director for the National Vaccine Information Center, an organization long criticized for promoting inaccurate information, criticized the CDC for glossing over side effects of hepatitis B vaccine such as fever, sleepiness and fussiness.

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“These are not trivial reactions,” Pebsworth said. “I personally think we should be erring on the side of caution and adopt a more prudent vaccination policy.”

Hepatitis B has been nearly eliminated since the vaccine was introduced in 1991.

Up to 85% of babies born to infected mothers become infected themselves, and the risk of long-term effects from the disease is higher the earlier the infection is acquired.

Infants infected in the first year of life have a 90% chance of developing chronic hepatitis B and 25% of those who do will die from complications such as liver cancer and cirrhosis, according to the American Academy of Pediatrics.

Side effects from the vaccine are extremely rare, CDC scientists told the committee Thursday, and those that do occur tend to be mild.

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Several committee members indicated they were unconvinced.

“There are gaps in what we know and understand about the effects of hepatitis B [vaccine], particularly on very young infants, and the conclusion that we know that it is safe is perhaps premature,” Pebsworth said.

At one point, she asked whether the irritability and fussing some babies showed at the time of the shot could be early symptoms of neurological problems stemming from the vaccine that hadn’t been studied.

At this, committee member Dr. Joseph Hibbeln pushed back.

“We have to vote on where there’s data of concrete harm or concrete benefit,” said Hibbeln, a psychiatrist who previously served as a section chief at the National Institutes of Health. “We’re going beyond data, and we’re turning into a discussion of speculation and possible clinical outcomes for which we have no data.”

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The American Academy of Pediatrics said in a news conference Thursday that it would continue to recommend that infants receive their first hepatitis B shot at birth.

America’s Health Insurance Plans, an association that includes major U.S. insurers such as Aetna, Humana, Kaiser Permanente, Cigna and several Blue Cross and Blue Shield groups, announced this week that its members would continue to cover all vaccines recommended by the CDC as of Sept. 1 through the end of 2026.

For most of its 61-year history, ACIP meetings have been dry, technical affairs in which committees of experienced physicians, public health officials and research scientists get deep into the weeds of vaccine and disease data.

The committee’s role in vaccine insurance coverage and availability in the U.S. is paramount. Insurers are only required to cover vaccines the CDC endorses, though they can choose to cover others as well. The committee’s recommendation has typically set the vaccine schedule followed by schools and physicians. It also determines what vaccines are covered by the CDC’s Vaccines for Children Program, which pays to immunize nearly half the nation’s children.

Previously, the committee collaborated year-round with expert working groups like the American Medical Assn., the American Academy of Pediatrics and the Infectious Diseases Society of America to craft its recommendations and guidelines. Members also served staggered terms, so that new people coming on always joined colleagues with previous experience, and often went through more than a year of vetting.

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But Kennedy fired the entire 17-member committee in June, and then informed medical groups they were no longer invited to review scientific evidence and advise the committee in advance of the meeting.

With the exception of Dr. Cody Meissner, who served on ACIP under presidents George W. Bush and Barack Obama, all of the members are new.

The lack of experience showed.

The group started the day by redoing a vote they’d hurriedly cast the previous afternoon on whether public funding would continue to cover the combined MMRV shot, as several members confessed to not fully understanding the text of the measure they’d voted on. In the new vote, they determined that it would not.

In August, Kennedy fired CDC Director Susan Monarez, who was appointed to the position by President Trump. On Wednesday, Monarez told a Senate committee that Kennedy fired her in part because she refused to sign off in advance on changes he planned to make to the vaccine schedule this month, without seeing scientific evidence for them.

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The ACIP’s recommendations become official only after the CDC director approves them. With Monarez out, that responsibility now goes to Health and Human Services Deputy Secretary Jim O’Neill, who is serving as the CDC’s acting director.

“This committee has focused on poorly done research that supports their preconceived anti-vaccine notions, rather than trying to truly weigh risks and benefits to get to the best decisions for American kids,” said Dr. Adam Ratner, a New York City pediatric infectious disease specialist. “This ACIP meeting demonstrates a sad deterioration of our public health systems, and real families and children will suffer as a result.”

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Pediatricians urge Americans to stick with previous vaccine schedule despite CDC’s changes

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Pediatricians urge Americans to stick with previous vaccine schedule despite CDC’s changes

For decades, the American Academy of Pediatrics and the U.S. Centers for Disease Control and Prevention spoke with a single voice when advising the nation’s families on when to vaccinate their children.

Since 1995, the two organizations worked together to publish a single vaccine schedule for parents and healthcare providers that clearly laid out which vaccines children should get and exactly when they should get them.

Today, that united front has fractured. This month, the Department of Health and Human Services announced drastic changes to the CDC’s vaccine schedule, slashing the number of diseases that it recommends U.S. children be routinely vaccinated against to 11 from 17. That follows the CDC’s decision last year to reverse its recommendation that all kids get the COVID-19 vaccine.

On Monday, the AAP released its own immunization guidelines, which now look very different from the federal government’s. The organization, which represents most of the nation’s primary care and specialty doctors for children, recommends that children continue to be routinely vaccinated against 18 diseases, just as the CDC did before Robert F. Kennedy Jr. took over the nation’s health agencies.

Endorsed by a dozen medical groups, the AAP schedule is far and away the preferred version for most healthcare practitioners. California’s public health department recommends that families and physicians follow the AAP schedule.

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“As there is a lot of confusion going on with the constant new recommendations coming out of the federal government, it is important that we have a stable, trusted, evidence-based immunization schedule to follow and that’s the AAP schedule,” said Dr. Pia Pannaraj, a member of AAP’s infectious disease committee and professor of pediatrics at UC San Diego.

Both schedules recommend that all children be vaccinated against measles, mumps, rubella, polio, pertussis, tetanus, diphtheria, Haemophilus influenzae type B (Hib), pneumococcal disease, human papillomavirus (HPV) and varicella (better known as chickenpox).

AAP urges families to also routinely vaccinate their kids against hepatitis A and B, COVID-19, rotavirus, flu, meningococcal disease and respiratory syncytial virus (RSV).

The CDC, on the other hand, now says these shots are optional for most kids, though it still recommends them for those in certain high-risk groups.

The schedules also vary in the recommended timing of certain shots. AAP advises that children get two doses of HPV vaccine starting at ages 9 to12, while the CDC recommends one dose at age 11 or 12. The AAP advocates starting the vaccine sooner, as younger immune systems produce more antibodies. While several recent studies found that a single dose of the vaccine confers as much protection as two, there is no single-dose HPV vaccine licensed in the U.S. yet.

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The pediatricians’ group also continues to recommend the long-standing practice of a single shot combining the measles, mumps and rubella (MMR) and varicella vaccines in order to limit the number of jabs children get. In September, a key CDC advisory panel stocked with hand-picked Kennedy appointees recommended that the MMR and varicella vaccines be given as separate shots, a move that confounded public health experts for its seeming lack of scientific basis.

The AAP is one of several medical groups suing HHS. The AAP’s suit describes as “arbitrary and capricious” Kennedy’s alterations to the nation’s vaccine policy, most of which have been made without the thorough scientific review that previously preceded changes.

Days before AAP released its new guidelines, it was hit with a lawsuit from Children’s Health Defense, the anti-vaccine group Kennedy founded and previously led, alleging that its vaccine guidance over the years amounted to a form of racketeering.

The CDC’s efforts to collect the data that typically inform public health policy have noticeably slowed under Kennedy’s leadership at HHS. A review published Monday found that of 82 CDC databases previously updated at least once a month, 38 had unexplained interruptions, with most of those pauses lasting six months or longer. Nearly 90% of the paused databases included vaccination information.

“The evidence is damning: The administration’s anti-vaccine stance has interrupted the reliable flow of the data we need to keep Americans safe from preventable infections,” Dr. Jeanne Marrazzo wrote in an editorial for Annals of Internal Medicine, a scientific journal. Marrazzo, an infectious disease specialist, was fired last year as head of the National Institute of Allergy and Infectious Diseases after speaking out against the administration’s public health policies.

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‘We’re not going away’: Rob Caughlan, fierce defender of the coastline and Surfrider leader, dies at the age of 82

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‘We’re not going away’: Rob Caughlan, fierce defender of the coastline and Surfrider leader, dies at the age of 82

Known by friends and colleagues as a “planetary patriot,” a “happy warrior” and the “Golden State Eco-Warrior,” Rob Caughlan, a political operative, savvy public relations specialist and one of the early leaders of the Surfrider Foundation, died at his home in San Mateo, on Jan. 17. He was 82.

His wife of nearly 62 years, Diana, died four days earlier, from lung cancer.

Environmentalists, political operatives and friends responded to his death with grief but also joy as they recalled his passion, talent and sense of humor — and his drive not only to make the world a better place, but to have fun doing it.

“He’d always say that the real winner in a surfing contest was the guy who had the most fun,” said Lennie Roberts, a conservationist in San Mateo County and longtime friend of Caughlan’s. “He was true to that. It’s the way he lived.”

“When he walked into a room, he’d have a big smile on his face. He was a great — a gifted — people person,” said Dan Young, one of the original five founders of the Surfrider Foundation. The organization was cobbled together in the early 1980s by a group of Southern California surfers who felt called to protect the coastline — and their waves.

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They also wanted to dispel the stereotype that surfers are lackadaisical stoners — and show the world that surfers could get organized and fight for just causes, said Roberts, citing Caughlan’s 2020 memoir, “The Surfer in the White House and Other Salty Yarns.”

Before joining Surfrider in 1986, Caughlan was a political operative who worked as an environmental adviser in the Carter administration. According to Warner Chabot, an old friend and recently retired executive director of the an Francisco Estuary Institute, Caughlan got his start during the early 1970s when he and his friend, David Oke, formed the Sam Ervin Fan Club, which supported the Southern senator’s efforts to lead the Watergate investigation of President Nixon.

According to Chabot, Caughlan organized the printing of T-shirts with Ervin’s face on them, underneath the text “I Trust Uncle Sam.”

“He was an early social influencer — par extraordinaire,” he said.

Glenn Hening, a surfer, former Jet Propulsion Laboratory space software engineer and another original founder of the Surfrider Foundation, said one of the group’s initial fights was against the city of Malibu, which in the early 1980s was periodically digging up sand in the lagoon right offshore and destroying the waves at one of their favorite surf spots.

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According to Hening, it was Caughlin’s unique ability to persuade and charm politicians and donors that put Surfrider’s efforts on the map.

Caughlan served as the foundation’s president from 1986 to 1992.

The foundation grabbed the national spotlight in 1989 when it went after two large paper mills in Humboldt Bay that were discharging toxic wastewater into an excellent surfspot in Northern California. The foundation took aim and in 1991 filed suit alongside the U.S. Environmental Protection Agency; the paper mills settled for $5.8 million.

Hening said the victory would never have happened without Caughlan.

The mills had tried to brush off the suit by offering a donation to the foundation, Hening said. But Caughlan and Mark Massara — an environmental lawyer with the organization — rebuffed the gesture.

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“The paper mill guys said, ‘Well, what can we do here? How can we make this go away?’” said Hening, recalling the conversation. “And Rob said, ‘It’s not going to go away. We’re not going away. We’re surfers.”

Roberts said Caughlan’s legacy can be felt by anyone who has ever spent time on the San Mateo County coastline. In the 1980s, the two spearheaded a successful ballot measure still protects the coast from non-agricultural development and ensured access to the beaches and bluffs. It also prohibits onshore oil facilities for off-shore facilities.

The two also worked on a county measure that led to the development of the Devil’s Slide tunnels on Highway 1 between Pacifica and Montara, designed to make that formerly treacherous path safer for travelers.

The state had wanted to build a six-lane highway over the steep hills in the area. “It would have been dangerous because of the steep slopes, and it would be going up into the fog bank and then back down out of the fog. So it was inherently dangerous,” Roberts said.

Chad Nelsen, the current president of the Surfrider Foundation, said he was first drawn into Caughlan’s orbit in 2010 when Surfrider got involved with a lawsuit pertaining to a beach in San Mateo County. Silicon Valley venture capitalist Vinod Khosla purchased 53 acres of Northern California coastline for $32.5 million and closed off access to the public — including a popular stretch known as Martin’s Beach — so Surfrider sued.

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Nelsen said that although Caughlan had left the organization about 20 years before, he reappeared with a “sort of unbridled enthusiasm and commitment to the cause,” and the organization ultimately prevailed — the public can once again access the beach “thanks to ‘Birdlegs.’”

Birdlegs was Caughlan’s nickname, and according to Nelsen, it was probably coined in the 1970s by his fellow surfers.

“He had notoriously spindly legs, I guess,” Nelsen said.

Robert Willis Caughlan was born in Alliance, Ohio, on Feb. 27, 1943. His father, who was a parachute instructor with the U.S. Army, died when Caughlan was 4. In 1950, Caughlan moved with his mother and younger brother to San Mateo, where he saw the ocean for the first time.

He rode his his first wave in 1959, at the age of 16, from the breakwater at Half Moon Bay.

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LAUSD says Pali High is safe for students to return to after fire. Some parents and experts have concerns

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LAUSD says Pali High is safe for students to return to after fire. Some parents and experts have concerns

The Los Angeles Unified School District released a litany of test results for the fire-damaged Palisades Charter High School ahead of the planned return of students next week, showing the district’s remediation efforts have removed much of the post-fire contamination.

However, some parents remain concerned with a perceived rush to repopulate the campus. And while experts commended the efforts as one of the most comprehensive post-fire school remediations in modern history, they warned the district failed to test for a key family of air contaminants that can increase cancer risk and cause illness.

“I think they jumped the gun,” said a parent of one Pali High sophomore, who asked not to be named because she feared backlash for her child. “I’m quite angry, and I’m very scared. My kid wants to go back. … I don’t want to give him too much information because he has a lot of anxiety around all of these changes.”

Nevertheless, she still plans to send her child back to school on Tuesday, because she doesn’t want to create yet another disruption to the student’s life. “These are kids that also lived through COVID,” she said.

The 2025 Palisades fire destroyed multiple buildings on Pali High’s campus and deposited soot and ash in others. Following the fire, the school operated virtually for several months and, in mid-April of 2025, moved into a former Sears department store in Santa Monica.

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Meanwhile, on campus, the U.S. Environmental Protection Agency and the U.S. Army Corps of Engineers cleared debris from the destroyed structures, and LAUSD hired certified environmental remediation and testing companies to restore the still-standing buildings to a safe condition.

LAUSD serves as the charter school’s landlord and took on post-fire remediation and testing for the school. The decision to move back to the campus was ultimately up to the charter school’s independent leadership.

The Los Angeles Department of Water and Power tested the drinking water for a slew of contaminants, and environmental consultants tested the soil, HVAC systems, indoor air and surfaces including floors, desks and lockers.

They tested for asbestos, toxic metals such as lead and potentially hazardous organic compounds often unleashed through combustion, called volatile organic compounds, or VOCs.

“The school is ready to occupy,” said Carlos Torres, director of LAUSD’s office of environmental health and safety. “This is really the most thorough testing that’s ever been done that I can recall — definitely after a fire.”

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Construction workers rebuild the Palisades Charter High School swimming pool.

(Allen J. Schaben / Los Angeles Times)

A handful of soil samples had metal concentrations slightly above typical post-fire cleanup standards, which are designed to protect at-risk individuals over many years of direct exposure to the soil — such as through yard work or playing sports. An analysis by the environmental consultants found the metals did not pose a health risk to students or staff.

On indoor surfaces, the consultants found two areas with lead and one with arsenic, spaces they recleaned and retested to make sure those metals were no longer present.

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The testing for contamination in the air, however, has become a matter of debate.

Some experts cautioned that LAUSD’s consultants tested the air for only a handful of mostly non-hazardous VOCs that are typically used to detect smoke from a wildfire that primarily burned plants. While those tests found no contamination, the consultants did not test for a more comprehensive panel of VOCs, including many hazardous contaminants commonly found in the smoke of urban fires that consume homes, cars, paints, detergents and plastics.

The most notorious of the group is benzene, a known carcinogen.

At a Wednesday webinar for parents and students, LAUSD’s consultants defended the decision, arguing their goal was only to determine whether smoke lingered in the air after remediation, not to complete more open-ended testing of hazardous chemicals that may or may not have come from the fire.

Andrew Whelton, a Purdue University professor who researches environmental disasters, didn’t find the explanation sufficient.

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“Benzene is known to be released from fire. It is known to be present in air. It is known to be released from ceilings and furniture and other things over time, after the fire is out,” Whelton said. “So, I do not understand why testing for benzene and some of the other fire-related chemicals was not done.”

For Whelton, it’s representative of a larger problem in the burn areas: With no decisive guidance on how to remediate indoor spaces after wildland-urban fires, different consultants are making significantly different decisions about what to test for.

LAUSD released the testing results and remediation reports in lengthy PDFs less than two weeks before students plan to return to campus, while the charter school’s leadership decided on a Jan. 27 return date before testing was completed.

At the webinar, school officials said two buildings near the outdoor pool have not yet been cleared through environmental testing and will remain closed. Four water fixtures are also awaiting final clearance from the Los Angeles Department of Water and Power, and the school’s food services are still awaiting certification from the L.A. County Department of Public Health.

For some parents — even those who are eager to ditch the department store campus — it amounts to a flurried rush to repopulate Pali High’s campus that is straining their decisions about how to keep their kids safe.

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Torres stressed that his team acted cautiously in the decision to authorize the school for occupancy, and that promising preliminary testing helped school administrators plan ahead. He also noted that the slow, cautious approach was a point of contention for other parents who hoped their students could return to the campus as quickly as possible.

Experts largely praised LAUSD’s efforts as thorough and comprehensive — with the exception of the VOC air testing.

Remediation personnel power washed the exterior of buildings, wiped down all surfaces and completed thorough vacuuming with filters to remove dangerous substances. Any soft objects such as carpet or clothing that could absorb and hold onto contamination were discarded. The school’s labyrinth of ducts and pipes making up the HVAC system was also thoroughly cleaned.

Crews tested throughout the process to confirm their remediation work was successful and isolated sections of buildings once the work was complete. They then completed another full round of testing to ensure isolated areas were not recontaminated by other work.

Environmental consultants even determined a few smaller buildings could not be effectively decontaminated and consequently had them demolished.

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Torres said LAUSD plans to conduct periodic testing to monitor air in the school, and that the district is open to parents’ suggestions.

For Whelton, the good news is that the school could easily complete comprehensive VOC testing within a week, if it wanted to.

“They are very close at giving the school a clean bill of health,” he said. “Going back and conducting this thorough VOC testing … would be the last action that they would need to take to determine whether or not health risks remain for the students, faculty and visitors.”

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