In May 2025, U.S. Secretary of Health and Human Services Robert F. Kennedy, Jr., announced that the COVID-19 vaccine would be removed from the recommended immunization schedule for healthy children and pregnant women. In bypassing the Advisory Committee on Immunization Practices, or ACIP — the federal government body that recommends vaccines to prevent disease — the administration’s action was unprecedented. The Centers for Disease Control and Prevention (CDC) ultimately retained the COVID vaccine on the children’s immunization schedule, though it changed the previous routine recommendation to “shared clinical decision-making” between patients and providers.
The following month, Kennedy removed all 17 members of ACIP and appointed eight new members, contending these changes are necessary to “restore public trust.” Public health experts characterized the replacements as “critics of the nation’s COVID-19 vaccine policies or those who don’t specialize in vaccine science.” In another move, ACIP staff positions were eliminated.
In this explainer, we discuss what ACIP does and who its members are, how it makes recommendations, and how the Trump administration’s actions may affect Americans’ ability to obtain affordable vaccines for themselves and their children.
Why was ACIP created and what does it do?
With the availability of new polio and measles vaccines in the early 1960s, U.S. policymakers decided that nation’s vaccine policy required a “greater degree of continuity of expert technical advice” than the previous ad hoc committees. To that end, in 1964, the U.S. Department of Health and Human Services (HHS) chartered the Advisory Committee on Immunization Practices.
ACIP begins assessing a new vaccine while the Food and Drug Administration (FDA) separately reviews its safety and effectiveness. After the FDA licenses a vaccine, ACIP typically votes on its recommendations for the vaccine’s use at its next meeting. It’s up to the CDC director whether to formally adopt ACIP’s recommendations. When circumstances warrant, ACIP issues guidance for unlicensed vaccines as well.
ACIP also approves annual child and adult immunization schedules that incorporate all its recommendations for clinicians.
Who sits on the vaccine committee?
ACIP can include up to 19 voting members, all of whom the HHS Secretary appoints. Members must have “clinical, scientific, and public health expertise in immunization,” and at least one member must be “knowledgeable about consumer perspectives and/or social and community aspects of immunization programs.”
The selection process requires applicants to disclose potential conflicts of interest, submit letters of support from experts, and complete an interview and background check. Members serve four-year terms, which historically have overlapped to avoid any disruption that could result from the entire committee comprising all new members.
ACIP also has nonvoting members, including six federal health officials representing the Health Resources and Services Administration, the FDA, the Centers for Medicare and Medicaid Services, the National Institutes of Health, the Indian Health Service, and the HHS Office of Infectious Disease and HIV/AIDS Policy. There are also at least 30 liaison representatives from professional organizations such as the American Academy of Pediatrics.
Because of its members’ expertise, ACIP recommendations have been considered the gold-standard for evidence-based guidance.
How does ACIP make its recommendations?
The full committee holds at least three public meetings each year to review and vote on recommendations. Members also participate in work groups that review evidence, solicit public comment, and present recommendations to the full committee.
Recommendations are adopted by majority vote. The CDC director decides whether to formally adopt ACIP recommendations by publishing them in its Morbidity and Mortality Weekly Report.
ACIP recommendations identify the population groups or circumstances for vaccine use, any contraindications and precautions, and recognized adverse events. Recommendations sometimes focus on “special situations or populations that may warrant modification of the routine recommendations.”
According to its charter, ACIP must consider the following when making recommendations:
- disease epidemiology and burden of disease
- vaccine safety
- vaccine efficacy and effectiveness
- the quality of evidence reviewed
- economic analyses
- implementation issues.
The committee weighs the benefits and possible harms of recommending a vaccine for a particular population. It can revise or withdraw recommendations if new information comes to light regarding disease epidemiology, vaccine effectiveness or safety, or economic considerations.
What role do ACIP recommendations play in vaccine coverage and access?
ACIP’s recommendations determine which vaccines are covered by nearly all insurers, including employer-sponsored plans; individual plans, including those purchased through the Affordable Care Act (ACA) marketplaces; Medicare Part D; state Medicaid programs, and the Children’s Health Insurance Program. (The exception is Medicare Part B, where federal law specifies coverage of certain vaccines.)
ACIP also develops the list of vaccines covered by the federal Vaccines for Children program, which provides free vaccines to about half of U.S. children, including those eligible for Medicaid, uninsured children, and American Indian/Alaska Native children.
The ACA requires health insurers to cover ACIP-recommended vaccines without copayments or other cost sharing. Research shows that cost-free coverage reduces access barriers and can control health care costs — including patients’ out-of-pocket costs, considered to be “the most significant predictor of failure to use preventive services.” One study found that unvaccinated individuals accounted for $7.1 billion in health care costs in one year, 80 percent of the cost of vaccine-preventable disease.
How might the Trump administration’s actions affect vaccine affordability and access?
Secretary Kennedy’s actions to remove the COVID-19 vaccine from the recommended immunization schedule for healthy children and pregnant women, replace ACIP’s membership, and cut staffing raise concerns about ACIP’s future as a respected expert body that develops recommendations on established scientific evidence. There are also potential implications for access to and affordability of both new and longstanding vaccines. At ACIP’s June 2025 meeting, the new chair announced that new work groups would review the “cumulative effect” of the childhood and adolescent vaccine schedule and assess vaccines that have not been reviewed in seven years, including hepatitis B administered at birth and the measles, mumps, rubella, and chicken pox childhood immunizations.
Failure to recommend a new vaccine or changes in existing recommendations could lead to rollbacks in insurance coverage of these services. That’s because without an ACIP recommendation, insurers would be free to decide which vaccines to cover and whether to impose cost sharing on patients. Potentially, private insurers, Medicare Part D plans, and state Medicaid programs will vary in their coverage of vaccines, creating confusion for patients and providers.
Vaccine access already is an area of public health concern. In many states, the share of children who have received all recommended early childhood vaccines is now below 75 percent and falling. Measles, considered eliminated in the U.S. in 2000 due to widespread vaccination, has been on the rise, as have whooping cough and other vaccine-preventable diseases.
Secretary Kennedy’s actions have prompted a backlash. In July 2025, a group of medical and public health associations, led by American Academy of Pediatrics, filed a lawsuit challenging the changes. Thirty medical and provider organizations wrote an open letter criticizing the removal of the recommendation for pregnant women in particular, amid reports that some patients have been unable to obtain the vaccine. Vaccine researchers also criticized Secretary Kennedy’s decision as unsupported by evidence.
It’s clear that changes made to the Advisory Committee on Immunization Practices’ membership and recommendations have the potential to influence health at the individual and population levels. They also could affect the country’s ability to effectively prevent and respond to public health crises in the future.
