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Jason L. Schwartz

@jasonlschwartz.bsky.social

1.3K followers 280 following 130 posts

Associate Professor of Health Policy and the History of Medicine, Yale School of Public Health. Vaccine policy, health policy-making, pharmaceuticals, FDA/CDC, etc. http://jschwartz.yale.edu

jschwartz.yale.edu

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Jason L. Schwartz @jasonlschwartz.bsky.social · Jun 18

Things are very bad for U.S. vaccination policy these days and are only going to get worse. In @nejm.org, I examine the recent news about COVID-19 vaccines and ACIP, what likely lies ahead, and what the medical and public health communities should do to lessen the damage www.nejm.org/doi/full/10....

Revised Recommendations for Covid-19 Vaccines — U.S. Vaccination Policy under Threat | NEJM

A series of recent actions by the Trump administration upend the country’s approach to Covid-19 vaccination and may portend a broader shift in the government’s role in protecting the public health.

www.nejm.org

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Jason L. Schwartz @jasonlschwartz.bsky.social · 3h

No FR announcement, inside 15-days, and now meeting date updated to “TBD” on ACIP website.

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Jason L. Schwartz @jasonlschwartz.bsky.social · 18h

One more plug for this webinar tomorrow afternoon. Not too late to register!

Jason L. Schwartz @jasonlschwartz.bsky.social · 19d

An opportune time to promote this virtual event coming up in a few weeks, hosted by the folks at @busph.bsky.social. (Too bad there’s not much to discuss!) Details and registration: publichealthconversation.org/conversation...

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Jason L. Schwartz @jasonlschwartz.bsky.social · 1d

This new NASEM report on vaccine safety was commissioned by CDC during the Biden administration but arrives in an entirely different vaccine policy landscape. www.nationalacademies.org/our-work/rev...

www.nationalacademies.org

Jason L. Schwartz @jasonlschwartz.bsky.social · 3d

The @factcheck.org team have done really thorough, careful work on 1000 vaccine-related claims during and since the pandemic. A fantastic resource and service that should get more attention.

FactCheck.org @factcheck.org · 4d

A substantial body of evidence supports the safety of the COVID-19 vaccines during pregnancy, contrary to the suggestions of some members of the CDC’s vaccine advisory committee. HHS Secretary Robert F. Kennedy Jr. recently reconstituted the committee.

www.factcheck.org/2025/10/vacc...

Jason L. Schwartz @jasonlschwartz.bsky.social · 4d

If there’s really going to be another ACIP meeting on October 22-23, FACA requires a Federal Register announcement (with topics and potential votes) no later than this Tuesday, 10/7 (15 days ahead)

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Jason L. Schwartz @jasonlschwartz.bsky.social · 4d

It doesn’t make a lot of sense that FDA is convening VRBPAC next week to make recommendations on the 2026 Southern Hemisphere flu vaccine strains when they didn’t have them meet last spring to consider the flu vaccine composition for the US itself this fall/winter. www.fda.gov/advisory-com...

VRBPAC October 9, 2025 Meeting Announcement

On October 9, 2025, the Committee will meet in open session to discuss and make recommendations on the following separate topics. Topic I: the strain selection for the influenza virus vaccines for the...

www.fda.gov

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Jason L. Schwartz @jasonlschwartz.bsky.social · 8d

Very glad that ICER is tackling this topic, its first-ever vaccine project!

Institute for Clinical and Economic Review (ICER) @icer-review.bsky.social · 8d

Institute for Clinical and Economic Review to Assess Vaccines for COVID-19: tinyurl.com/2tfn5pme

Institute for Clinical and Economic Review to Assess Vaccines for COVID-19 - ICER

Report will be subject of New England CEPAC meeting in June 2026.

tinyurl.com

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Jason L. Schwartz @jasonlschwartz.bsky.social · 12d

Thanks for flagging this, Dan! Will make sure it’s fixed.

Jason L. Schwartz @jasonlschwartz.bsky.social · 12d

And here’s the final version. ysph.yale.edu/news-article...

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Jason L. Schwartz @jasonlschwartz.bsky.social · 15d

Sounds like we’ll be hearing a lot about aluminum in vaccines next. Great resource from the team at CHOP: www.chop.edu/vaccine-educ...

Vaccine Ingredients: Aluminum

Aluminum is used in vaccines as an adjuvant. Aluminum adjuvants are used in vaccines such as hepatitis A, hepatitis B, diphtheria-tetanus-containing vaccines, Haemophilus influenzae type b, and pneumo...

www.chop.edu

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Jason L. Schwartz @jasonlschwartz.bsky.social · 15d

More about this committee, its members, and agendas available here: portal.ct.gov/dph/working-...

Advisory Council to Advise the Commissioner

portal.ct.gov

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Jason L. Schwartz @jasonlschwartz.bsky.social · 15d

Glad to serve on a new advisory committee to the Connecticut Dept. of Public Health focusing on vaccination. Our first meeting today discussed changing ACIP recs., the resulting confusion, and the many challenges providers face discussing and delivering vaccines. Video: ct-n.com/ctnplayer.as...

CT-N Video Player: Department of Public Health Advisory Commission to Advise the Commissioner September 22nd Meeting

ct-n.com

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Jason L. Schwartz @jasonlschwartz.bsky.social · 16d

What’s your favorite paper or two on both—really interesting—statements here? Would love to read and think more about both.

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Jason L. Schwartz @jasonlschwartz.bsky.social · 16d

Our YSPH Communications office asked me to do a Q&A about the ACIP meeting. (Focusing on the actual outcomes and votes, not all of the process chaos and dubious scientific content.) A shortened version will be posted on our website sometime this week, but here it is now, all 1400 words of it:

Q1. First of all, how did we get here?

Last week’s ACIP meeting was the latest installment in what’s been an incredibly busy and, frankly, confusing past few months for vaccine policy—and for COVID vaccines, in particular.
To briefly recap how we got here:

— In late May, HHS Secretary Robert F. Kennedy, Jr., announced on social media that CDC would no longer recommend COVID vaccines for pregnant women and healthy children.

— A few weeks later, the entire membership of the ACIP was dismissed, an unprecedented action, and replaced with a new group a few weeks later. (Several more members were added this month.)

— Over the summer, medical professional societies including the American Academy of Pediatrics and American College of Obstetricians and Gynecologists and many state public health departments issued their own vaccine recommendations that endorsed the continued, broad use of COVID vaccines, including for pregnant women and previously unvaccinated children.

— Last month, the Food and Drug Administration (FDA) approved the updated COVID vaccines available this fall, but only for adults over age 65 and younger individuals with a condition that places them at increased risk of severe outcomes from COVID. The CDC has published a list of those conditions; notably, pregnancy is among those included.

Q2. So what are the new ACIP guidelines for the fall COVID vaccine?

The ACIP added still more complexity to the COVID vaccination story at their recent meeting. They voted to update the childhood and adult recommended immunization schedules to state that COVID vaccines can be administered to anyone 6 months of age or older based on individual decision-making that is informed by a discussion with a physician or another health care provider. As of this writing, this vote is awaiting adoption by the acting CDC director, upon which it would become an official CDC guideline.

This “shared clinical decision-making” statement, as it’s also called, is a step down from the ACIP’s far more common, “routine” recommendations. It is used in situations where the committee wishes to highlight vaccination as an option for individuals (i.e., “may vaccinate”) without actively encouraging its use (i.e., “should vaccinate”). Importantly, it is still formally considered an ACIP recommendation for COVID vaccination, meaning that, if adopted, it will appear on CDC/ACIP immunization schedules and will therefore ensure continued no-cost coverage of COVID vaccines for all children regardless of insurance status and for all adults with private insurance, Medicare, or Medicaid. (Coverage of vaccines for uninsured adults remains an unfortunate gap in our health care system.)

Q3. Can someone still get a COVID vaccine if they are not eligible under the guidelines?

The population covered by this new ACIP recommendation—all individuals over 6 months of age (the earliest age at which any COVID vaccine can be administered)—is considerably larger than the groups for whom the vaccines are currently approved by the FDA. While it is not unprecedented for CDC/ACIP to endorse the use of a vaccine outside the margins of its FDA approval—what’s referred to as “off-label use”—it is quite uncommon and, unlike the widespread off-label use of pharmaceuticals, typically reserved for small populations in very limited circumstances. Here, ACIP has opened the door to off-label use of the vaccine for tens of millions of Americans, essentially all healthy individuals between 6 months and 65 years of age.

Given the novelty of these circumstances, medical organizations, pharmacies, states, insurers, and other groups are currently sorting out the implications of ACIP’s recommendation, FDA’s narrowed approval of this year’s vaccines, and related implementation concerns.

There is wide variation in state laws and regulations regarding where vaccines can be administered, by whom, and in what circumstances. Policy updates are therefore required in some states, several of which were being made even before this ACIP meeting.

But when that work is completed, it’s quite likely that in most states, virtually anyone wishing to get a COVID vaccine this year should be able to do so, in most of the same locations—including pharmacies—where COVID vaccines have been available previously, and at no cost to them. Individuals seeking information regarding vaccine access and eligibility in their area should consult their health care provider, pharmacy, or state/local health department for more specific information.

Q4. I’ve been vaccinated before. Do I still need to get a COVID vaccine this year?

It depends, according to health experts. Even before all of this year’s tumult regarding vaccine policy, medical and public health officials had been signaling a move away from the prior practice of recommending annual COVID vaccines for virtually everyone regardless of age, health status, or prior vaccination history. In fact, the former ACIP had been working on updated, narrower COVID vaccine recommendations for this fall when they were dismissed.

The current ACIP vote on COVID vaccination allows for broad use of the vaccine, but it doesn’t identify any priority groups for vaccination other than those 65 years or older. However, the other medical and public health organizations that released COVID vaccine recommendations this summer have indicated groups for whom COVID vaccines are especially important. Here in Connecticut, for example, COVID vaccination is specifically recommended for:

— previously unvaccinated children
— adults 65 years and older
— pregnant women
— individuals of any age who are immunocompromised or with underlying risk factors for
severe COVID illness

The Connecticut recommendations note that these groups should be vaccinated, while other groups—healthy, previously vaccinated children and adults under age 65–may be vaccinated if they desire. There’s significant alignment across the many (non-ACIP) COVID vaccine recommendations issued by medical and public health organizations this summer, largely echoing these same priority groups for vaccination. In all cases, the best source for information regarding personal vaccination recommendations and decisions is one’s health care provider.

Q5. Did guidelines for the pediatric MMR vaccine change?

Not for the MMR vaccine itself, but for a related vaccine, and only a minor change was made.
Since 2005, a vaccine has been available that combines measles-mumps-rubella (MMR) and varicella (chickenpox) into a single vaccine known as MMRV. But for many years, the ACIP had recommended that children under age 4 receive the first doses of the MMR and varicella vaccines separately due to evidence of a slight increase in the occurrence of a rare vaccine-related adverse event in children receiving the combined MMRV vaccine. However, those prior recommendations gave parents of children in this age group the option to choose MMRV for this first dose if they preferred it, perhaps because it meant one fewer injection for their child. Only 15% of parents selected this non-preferred option. The new ACIP voted at last week’s meeting to eliminate that option and only recommend separate MMR and varicella vaccines in this very specific situation.

No changes were made regarding recommendations for the MMR and varicella vaccines themselves, which have demonstrated extremely high levels of safety and effectiveness throughout their decades of use. High rates of MMR vaccine remain particularly important in light of the nearly 1,500 cases of measles in the US this year, over 90% of which occurred in individuals without evidence of vaccination.

Q6. What about the Hepatitis B vaccine?

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Jason L. Schwartz @jasonlschwartz.bsky.social · 17d

In short, it’s just a mechanism for providers/programs that streamlines vaccine administration for those who want it. No one is being ‘ordered’ to get the vaccine because of it! A nice 1-pager from Immunize.org www.immunize.org/wp-content/u...

Jason L. Schwartz @jasonlschwartz.bsky.social · 17d

Only two possibilities here, both of them mind-boggling: an ACIP member genuinely doesn’t know what a vaccine ‘standing order’ means (Vaccine Policy 101), or he does and has no problem spreading falsehoods.

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Jason L. Schwartz @jasonlschwartz.bsky.social · 18d

Earlier this summer, I wrote about how a shift toward greater use of individual (‘shared’) decision-making recommendations from ACIP seemed likely given what we heard and saw from federal health officials all year long re: vaccines and their view of the role of government public health agencies…

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Jason L. Schwartz @jasonlschwartz.bsky.social · 18d

Some background on the history, role, and complexity of shared clinical decision-making recommendations for vaccines, given that’s where we seem to be now re: COVID vaccination www.cambridge.org/core/journal...

Shared Decision-Making and Prevention Recommendations: Evolution, Implications, and Challenges for Public Health | Journal of Law, Medicine & Ethics | Cambridge Core

Shared Decision-Making and Prevention Recommendations: Evolution, Implications, and Challenges for Public Health - Volume 49 Issue 3

www.cambridge.org

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Jason L. Schwartz @jasonlschwartz.bsky.social · 18d

It sounds like they just are non-binding ‘sense of the committee’ resolutions. Not the kind of thing that ACIP has ever turned into votes previously.

Jason L. Schwartz @jasonlschwartz.bsky.social · 18d

As the chair acknowledged just now, they can express the “sense of the committee” on this point, but they have no authority on this point. State matter.

Jason L. Schwartz @jasonlschwartz.bsky.social · 18d

They can express an opinion here, and it might complicate state implementation efforts depending on existing state law/regs, but what exactly a vaccine prescription means and who can prescribe them (including pharmacists) is a state matter and quickly gets complicated. (A topic for health law!)

Jason L. Schwartz @jasonlschwartz.bsky.social · 18d

That’d be a non-binding ‘sense of the committee’ statement, as I read it. (Not really within their authority to do more than that.) States would still have primary authority for these considerations, including through standing orders and other mechanisms.

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Jason L. Schwartz @jasonlschwartz.bsky.social · 18d

Perhaps grading on a curve here, but not as bad as I was expecting? If passed, these would preserve coverage requirements and not totally undermine efforts by other entities to more actively encourage vaccination, especially for higher-risk groups.

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Jason L. Schwartz @jasonlschwartz.bsky.social · 19d

Yes! Exactly the types of affordability/access divides that VFC was created in ‘94 to address. (And it’s done so!) The immediate issue here is a pretty niche one—15% of families who opted for a non-preferred option for 1 dose of 1 vaccine—but likely a harbinger of more consequential changes to come.

Rachel Sachs @rachelsachs.bsky.social · 19d

Thread. ACIP's reversal this morning imposes new financial barriers to accessing the MMRV vaccine for VFC-eligible families, while AHIP's public statements mean that privately insured families will continue to have access with no cost-sharing, at least for now.

Jason L. Schwartz @jasonlschwartz.bsky.social · 19d

They reversed the confusing VFC vote that would have preserved MMRV coverage for kids <4. But contrary to how the chair described the effect of this new vote, it really just means that VFC-eligible families of <4 kids won’t have free access to MMRV (which they no longer recommend) even if desired.

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Jason L. Schwartz @jasonlschwartz.bsky.social · 19d

Yes!