By Rose Hoban
On June 9, word started to spread that the U.S. Secretary of Health and Human Services Robert F. Kennedy Jr. had unilaterally ended the terms of all 17 members of the Advisory Committee on Immunization Practices (known commonly as ACIP), the committee within the Centers for Disease Control and Prevention that makes recommendations on which vaccines to use in the U.S.
Noel T. Brewer, a psychologist and distinguished professor of health behavior at the Gillings School of Global Public Health at UNC Chapel Hill was one of those committee members whose terms were abruptly ended.
Brewer, who has been at the Gillings School since 2004 and, at times, has been one of the most widely cited scientists in the world, is an expert in health behaviors. His work includes helping people understand risk and make better decisions about vaping and smoking. He’s also studied what works to increase vaccine acceptance and how to help physicians talk to their patients about vaccines.
Last week, the newly reconstituted ACIP — composed of eight people hand-picked by Kennedy, and including some well-known vaccine skeptics — convened for the first time. They made decisions about the use of the mercury-based preservative thimerosal in multidose vials of flu vaccine and heard presentations about COVID-19 vaccines and a vaccine for a common respiratory virus that’s a risk to young children.
On Thursday, Brewer spoke to NC Health News about what he was seeing and hearing during the meeting, which, as usual, was available to view on the internet.
This interview has been edited for length and clarity.
NC Health News: What are your general impressions as to what was talked about at the meeting?
Dr. Noel T. Brewer: The CDC presentations have been of exceptionally high quality, as they always are. I don’t see any compromises so far in terms of what they’ve been presenting. As a member of the ACIP work group on COVID-19 vaccines, I helped to review and approve most of the slides that were presented.
NCHN: What kind of vetting do you have to go through to become a member of the Advisory Committee on Immunization Practices?
Brewer: I was invited to apply by a senior CDC official, and I did that. And then a year and a half later, I received my invitation to join the committee. There’s a long application process — a lengthy series of forms, which I then submitted. That then went through various levels of vetting within CDC. And once that was done, things went from CDC over to DHHS, and the secretary of health and human services approved my committee service.
NCHN: What background did you have that you felt made you a good member of ACIP?
Brewer: I understand the problems that doctors face when recommending vaccines, having studied that for years. So one of my main areas is health care provider communication on vaccines. I also understand clinical trials as well as cost-effectiveness analysis. Those are two things that are fundamental to understanding the data that are presented at ACIP meetings.
I think being a regular contributor to the scientific literature is helpful.
NCHN: One of the things that Secretary Kennedy has complained about is purported conflicts of interest among ACIP members.
Brewer: The current members, when I was on ACIP, did not have current conflicts of interest. There was one or two that were managed in some way, but they were really quite trivial and all very transparently communicated. There are three categories for conflict of interest: You cannot accept consulting money from a drug company, a grant from a drug company or be involved in a lawsuit against a drug company.
NCHN: How would the CDC find “vaccine experts” who’ve never had any input from industry?
Brewer: I have no idea who those people would be. You certainly can’t have inventors of vaccines who do not have relationships to industry. The idea of creating a vaccine is that you want it to be used, and that requires partnering with large companies that will then be able to manufacture and distribute the vaccine.
Being in favor of vaccines is not a conflict of interest. In fact, it might be a qualification. I might instead say that people who have preconceptions about vaccines being harmful, without having a basis in evidence, may actually be more problematic.
NCHN: There was a discussion of thimerosal. What is thimerosal? What does it do? Why is it in vaccines?
Brewer: Thimerosal is a preservative that was used in vaccines maybe 20 years ago. It’s used almost not at all, currently. The U.S. stopped using thimerosal in vaccines because of activists making a big noise about it, not because of any problematic evidence. There’s decades of evidence showing the safety of thimerosal. That said, they’ve learned how to include less and less of it, and the kind of mercury is not methylmercury, it’s ethylmercury, which has a much shorter half life in the body. So there’s a lot of confusion, and a lot of the literature that’s cited as the incorrect kind of mercury.
NCHN: How did you find out that you had been eliminated from the ACIP?
Brewer: I received an email from a journalist who was sharing an article with me that was published in The Wall Street Journal. I read the article, and it said that RFK Jr., the secretary of health and human services, was firing all the ACIP members. That was around four on Monday, June 9, and that night, all of us gathered on a call. I shared the message with all of them, and then one by one, we started to get our notifications. I got mine at 5:48 p.m.
NCHN: Have you been in contact with other former ACIP members?
Brewer: Yes, we wrote, we wrote a paper in JAMA, and we have ongoing collaborations.
NCHN: Do you have concerns with the committee as it’s currently configured?
Brewer: I don’t know that my concerns matter. What matters is that we need to have good vaccine recommendations to guide clinical practice, and health care providers have just said, “No.” The professional organizations do not trust this new committee, and so the new committee is gonna have to work really hard to regain their trust. Based on what I saw in the meeting, that’s not going to happen anytime soon.
NCHN: Do you mind me asking how much money you made from being on ACIP?
Brewer: I think in my conflict of interest declarations, I said it was something like less than $2,000 a year, because we get paid by ACIP, maybe $200, $250 a day when we travel to Atlanta. So, I have had four days of service. Well the day that we did remotely, I don’t think I was paid for. So I think so far, I’ve probably gotten about $500, and I spent three weeks of time working on ACIP business. It’s largely volunteer work.
NCHN: How much time would you have spent preparing for each meeting?
Brewer: Between half a day and a day. It would depend on the meeting and the amount of materials that are available and how much I’d seen before.
NCHN: Are you going to step out of the limelight for a little while and go back to what you were doing?
Brewer: I don’t think it’s possible to step out of the limelight. This is going to be an evergreen for many years. As long as we have this secretary of health and human services, vaccination is going to be a topic of vigorous discussion.
NCHN: Have you been talking to folks, for example, in Texas and Oklahoma, where there’s been this big measles outbreak? Have you been engaged at all?
Brewer: I have not. I do serve on a committee that certifies the measles elimination status for the United States. And we are concerned about whether the U.S. will be able to prevent measles from becoming endemic. Currently, all the measles in the United States comes from other places and is passed around for a few people and dies out. There’s a big concern that this latest explosion of measles in the U.S. can make measles become a regular disease here.
NCHN: Your expertise is how physicians communicate with patients about vaccines. What would you suggest that providers be doing to help their patients understand what choices to be making?
Brewer: There’s no replacement for talk. The best thing that anyone can do is to talk to your doctor or their other health care provider. They know you, they know your health and they know vaccines. Go talk to them, and they’ll be able to help you sort all this stuff out.
NCHN: What if you don’t have a regular primary care provider?
Brewer: Children who are uninsured can go to county health departments [in North Carolina]. Children who are uninsured can get vaccines for free through the Vaccines for Children program. So you shouldn’t worry about being able to afford vaccines, because vaccines that are recommended by ACIP receive first-dollar coverage for private insurance and then are also covered through the Vaccines for Children program. Half of the nation’s children get vaccines through the Vaccines for Children program.
NCHN: This is one of the concerns that people have — if ACIP declines to recommend vaccines, it could affect the Vaccines for Children program.
Brewer: Exactly. That’s one of the big concerns.
NCHN: Why have vaccines become such a flash point?
Brewer: There has been concern about vaccines since they first came out. You can go back to books from the 1800s, like Nittinger’s Evils of Vaccination, and find stories of people harmed by vaccines. Not all those stories are true, but they are very powerful, they captured people’s imagination.
People who oppose vaccination have learned to harness these stories to maximum effect, and they become increasingly savvy about changing public policy to suit their needs. The vast majority of Americans favor vaccination, and even many of them favor vaccine mandates for infectious diseases to prevent infectious diseases like measles in schools. So the anti-vaccine folks, I think, are punching above their weight. They’re formidable and are being highly effective.
They’ve been really good at leveraging social media to make their numbers appear larger than they are.
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