Much of the former CDC director Susan Monarez’s, PhD, hearing before the Senate Committee on Health, Education, Labor and Pensions Sept. 17 centered on what HHS Secretary Robert F. Kennedy reportedly told her about plans to alter the childhood vaccine schedule before she was dismissed from the role.
Dr. Monarez was ousted as director in late August, after less than a month in the role. During the three-hour hearing, she recounted a series of interactions with the HHS secretary that led to her firing, including a “tense” Aug. 25 meeting in which she said Mr. Kennedy demanded she pre-approve recommendations crafted by the agency’s Advisory Committee on Immunization Practices. Dr. Monarez said she was fired after not agreeing to sign off on the guidance and refusing to fire career scientists from the agency. Mr. Kennedy, who appeared before the Senate Finance Committee Sept. 4, claims he fired her because she was not “trustworthy,” which Dr. Monarez refuted during her hearing.
“He directed me to commit in advance to approving every ACIP recommendation, regardless of the scientific evidence,” Dr. Monarez said in her opening remarks. “Even under pressure, I could not replace evidence with ideology or compromise my integrity.”
The hearing was held one day before the ACIP is set to meet. They are expected to vote on recommendations on who should receive updated COVID vaccines, changes to the hepatitis B vaccine schedule and measles vaccines. Mr. Kennedy began overhauling the ACIP in June, appointing a new roster of hand-picked members that includes individuals who have a history of anti-vaccine rhetoric.
Dr. Monarez testified alongside Debra Houry, MD, the CDC’s former chief medical officer who resigned along with several other top agency leaders following the director’s dismissal.
Here are two more key takeaways from the hearing:
Possible changes to the childhood vaccination schedule: Dr. Monarez said her former boss told her he planned to make changes to the childhood vaccination schedule — which includes recommendations on routine vaccinations such as chickenpox, measles and hepatitis B — in September. In response to a question from Louisiana Sen. Bill Cassidy, MD, Dr. Monarez said the HHS secretary told her during an August meeting that he had spoken to President Donald Trump “every day” about changing the childhood vaccination schedule.
In response, Dr. Monarez testified that she told Mr. Kennedy she would be open to changing recommendations on childhood vaccine schedules, “if the evidence or science were supportive.”
“He responded that there was no science or evidence associated with the childhood vaccination schedule,” Dr. Monarez said.
According to Dr. Monarez, Mr. Kennedy also requested she meet with Aaron Siri, an attorney who has called for the federal government to withdraw its approval of the polio vaccine.
Potential changes to recommendations on when children should receive the hepatitis B vaccine came up several times during the hearing. ACIP is expected to discuss and potentially vote on a decision that would change the age recommendation on when children receive a vaccine for the infection from birth to age 4 during the two-day meeting.
“I do want them to keep it at birth,” Dr. Houry said in response to a question from Massachusetts Sen. Ed Murkey. “I think there’s a lot of moms that don’t know that they have hepatitis that can then transmit it to their baby, and even if the mom is hepatitis B negative, we don’t know what the home situation is.”
Kentucky Sen. Rand Paul pressed Dr. Monarez on the current recommendation for hepatitis B shots, saying there is no “medical reason” for newborns whose mothers do not have the infection to receive the vaccine, and that the current recommendations “force” 6-month-olds to be vaccinated.
At the end of the hearing, Dr. Cassidy pushed back on claims that current recommendations mandate newborns receive a dose of the hepatitis B vaccine and drew on his 20 years of medical practice when discussing efficacy data on the shot.
“If you accept [vaccination,] the insurance company has to pay,” he said. “It’s not mandated. If you think it is a good idea, accept it.”
More than 90% of children who are infected with hepatitis B develop chronic infection, he said, adding that infections in newborns dropped by 68% in the decade following approval of the vaccine. If ACIP changes the recommendation, insurers would no longer be required to cover the dose for newborns.
CDC leaders said they were not told in advance of new COVID-19 vaccine guidance: When asked by Washington Sen. Patty Murray how she learned of new CDC recommendations issued in May that COVID vaccines are no longer recommended for healthy children and pregnant women, Dr. Houry said she learned of the update on social media. Agency leaders were not presented with data that indicated a need for the shift, she said.
“We have not received the data to date,” Dr. Houry said.
“It is unthinkable to me that the chief medical officer at CDC was left in the dark about such a consequential public health decision that affected real people,” Ms. Murray said.
In August, the FDA limited approval of updated COVID shots to individuals 65 years and older, and those with at least one condition that puts them at high risk for severe disease. Healthcare groups have criticized the decision to narrow eligibility criteria, saying it will cause confusion and create new access hurdles.
A growing number of states are now issuing their own orders to ensure broad access to the vaccine ahead of respiratory virus season. In many cases, the orders allow pharmacists to bypass ACIP recommendations and administer vaccines without individual prescriptions.
