Flu Vaccines Are a Go

What might the committee do?

That was the question on the minds of a lot of health care professionals, public policy leaders, public health officials, and select politicians going into the first meeting of the new Advisory Committee on Immunization Practices (ACIP) in June 2025. Prior to the past month, very few laypersons (and even pharmacists prior to gaining immunization privileges over the past decade and a half) had ever heard of or had a working knowledge of what ACIP is and what it does.

Image Credit: Sherry Young | stock.adobe.com

ACIP is more than 60 years old, having had its first meeting in May 1964.¹ Their role is to make recommendations as an official federal advisory committee and have open meetings with public participation and publicly available inputs and reports. Votes are cast and recommendations made, none of which bind the CDC or the US Department of Health and Human Services (HHS), though it is rare for the CDC not to follow ACIP’s recommendations. Importantly, ACIP’s recommendations do have a strong influence, if not a mandate, on health insurance companies with respect to coverage and co-payments for immunizations as well as the Vaccines for Children Program, which provides coverage for access to vaccines for those who are 18 years or younger.²

Recently, all 17 members of the existing ACIP committee were removed by the HHS Secretary Robert F. Kennedy Jr, and 8 have been appointed as replacements. Ultimately, 1 appointee did not move forward, and the 7 new members of the committee had their first meeting on June 25 and 26.

ACIP has become a small but growing part of the national consciousness thanks to reporting on its appointments, its membership, and the potential deviations from past proceedings and decision-making. Importantly, these proceedings have historically been quite uncontroversial, if not boring, to most observers who are not immersed in public health or those who have a role in vaccine products, such as an employee of a vaccine manufacturer.

A lot of anticipation built up prior to this committee meeting, given that its new committee members have more unconventional backgrounds. There was a great deal of uncertainty about how the proceedings might diverge from the conventional and whether there would be dramatic changes to vaccine recommendations previously thought to be noncontroversial. There was some worry that vaccine recommendations might come to a halt, stall, or diverge from past ACIP recommendations that manifest in vaccine schedules for newborns, children, and adults.

The net result thus far is (mostly) conventional, but with some caveats.

Over the course of the proceedings, the committee discussed concerns about vaccine safety and amplitudes of morbidity and mortality as considerations for vaccine recommendation, culminating in a focus on thimerosal, a preservative that has a history of both scrutiny and study.

Thimerosal out, everything else in.

Ultimately, the expected vaccine recommendations were made, save for the committee’s recommendation to more or less do away with thimerosal (formally doing so with influenza vaccines). As now widely reported, 95% of current influenza vaccinations are thimerosal-free, and those with thimerosal are used more widely internationally, where storage and handling processes and environments lean more heavily on preservatives for multidose vials. Aside from renewed scrutiny on mRNA vaccines (that emerged during COVID-19 vaccination efforts and extends now into 2025), it appears that outright opposition to vaccinations as a means of prevention and public health efforts is not on the agenda, at least at this early stage of new membership to the committee.

Single-dose syringes may become even more mainstream.

One result of a fixation on the safety of preservatives in vaccines could be an even greater use of single-use syringes, already quite popular for use in community pharmacies as both workflow and protocol-friendly options. What pharmacy has largely adopted from a process and supply chain perspective may now translate more readily to other vaccination environments such as medical clinics or public health departments.

ACIP recommendations are becoming more relevant than ever.

Following ACIP proceedings and upcoming recommendation agendas may be of import to pharmacy workforce and pharmacy owners and managers in order to anticipate what may come for a given season or year-round ordering and planning for vaccinations, their encounters, billing, and patient care activities. Many pharmacies provide vaccination clinics in both public and private venues, increasingly with employers who may have questions about vaccinations and vaccine planning, given the public’s media consumption of information and reporting.

Discussions, trust capital, and service provider for the community.

Over 90% of adult vaccinations now occur in a community pharmacy in addition to millions of childhood vaccinations.³ The community pharmacy workforce is trusted and believed by most to be purveyors of accurate and timely information about both medications and now vaccines. Keeping up to date on proceedings and popular discussion is now just as important as keeping up with the ACIP recommended and CDC approved schedules. Pharmacy workforce members will no doubt receive questions they’ve likely never before encountered and perhaps in greater volume.

REFERENCES

1. Smith JC, Hinman AR, Pickering LK. History and evolution of the Advisory Committee on Immunization Practices — United States, 1964-2014. Morb Mortal Wkly Rep MMWR. 2014;63(42):955-958.

2. First meeting of new ACIP committee touches on RSV, thimerosal, mRNA vaccines and more. BioSpace. Updated June 27, 2025. Accessed June 30, 2025. https://www.biospace.com/live/cdc-vaccine-advisors-convene-for-first-meeting-since-rfk-jr-sacip-overhaul

3. Assessing the impact of state pharmacist vaccination authority on vaccine intake in the US. IQVIA. February 25, 2025. Accessed June 30, 2025. https://www.iqvia.com/insights/the-iqvia-institute/reports-and-publications/reports/assessing-the-impact-of-state-pharmacist-vaccination-authority-on-vaccine-uptake-in-the-us