Advisory Committee on Immunization Practices

The Advisory Committee on Immunization Practices (ACIP) provides advice and guidance on effective control of vaccine-preventable diseases in the U.S. civilian population. The ACIP develops written recommendations for routine administration of vaccines to the pediatric and adult populations, along with vaccination schedules regarding appropriate periodicity, dosage, and contraindications. ACIP statements are official federal recommendations for the use of vaccines and immune globulins in the U.S., and are published by the Centers for Disease Control and Prevention.

Objectives

The overall goals of the ACIP are to provide advice to government agencies for reducing the incidence of vaccine preventable diseases and to increase the safe usage of vaccines and related biological products. In the U.S., immunizations have resulted in the eradication of smallpox, polio, measles, and rubella, and disease rates from vaccine-preventable diseases have been reduced by 99%. [cite web |url=http://cdc.gov/vaccines/pubs/vacc-timeline.htm |date=2006-10-19 |accessdate=2008-01-31 |title= Vaccine timeline |publisher= National Center for Immunization and Respiratory Diseases]

Recommendation process

Regularly scheduled ACIP meetings are held three times a year. Notices of each meeting, along with agenda items, are published in the Federal Register in accordance with the requirements of the Federal Advisory Committee Act (FACA). A vote on vaccine recommendations may be taken when a quorum of at least eight eligible ACIP members are present. Eligible voters are those members who do not have a conflict of interest. If there are not eight eligible voting members present, the ACIP executive secretary can temporarily designate ex officio members as voting members, as provided in the committee charter.

Their process includes review of labeling and package inserts; review of the scientific literature on the safety and efficacy; assessment of cost effectiveness; review of the morbidity and mortality associated with the disease; review of the recommendations of other groups; and consideration of the feasibility of vaccine use in existing programs.

At meetings the ACIP may vote to include new vaccines into the VFC program or to modify existing vaccine schedules. These votes are codified as VFC resolutions. In most cases, a resolution takes effect after establishing a CDC contract for the purchase of that vaccine in the necessary amounts. [cite web |url=http://cdc.gov/vaccines/programs/vfc/acip-vfc-resolutions.htm |date=2007-10-29 |accessdate=2008-01-31 |title= The ACIP-VFC vaccine resolutions |publisher= National Center for Immunization and Respiratory Diseases]

Working groups

To ensure thorough review of available information, ACIP often appoints working groups to assist drafting its recommendations, composed of ACIP members, CDC staff and others with immunization expertise.

Compulsory immunizations

Most states in the U.S. have adopted ACIP vaccine recommendations and mandate immunization before enrollment in public school, [cite journal |journal=Pediatrics |date=2005 |volume=115 |issue=5 |pages=1428–31 |title= Responding to parental refusals of immunization of children |author= Diekema DS, American Academy of Pediatrics Committee on Bioethics |doi=10.1542/peds.2005-0316 |pmid=15867060 |url=http://pediatrics.aappublications.org/cgi/content/full/115/5/1428] while allowing religious or philosophical exemptions to vaccination. [cite news |url=http://www.usatoday.com/news/nation/2007-10-17-19819928_x.htm |date=2007-10-17 |accessdate=2007-11-24 |author= LeBlanc S |title= Parents use religion to avoid vaccines |work= USA Today]

Members

The ACIP nominally contains fifteen regular members, each an expert in one of the following fields:cite web |title= ACIP charter |date=2007-12-10 |accessdate=2008-01-31 |url=http://cdc.gov/vaccines/recs/ACIP/charter.htm |publisher= National Center for Immunization and Respiratory Diseases]
*immunization practices and public health
*use of vaccines and other immunobiologic agents in clinical practice or preventive medicine
*clinical or laboratory vaccine research
*assessment of vaccine efficacy and safety
*consumer perspectives and/or social and community aspects of immunization programs; at least one member must be an expert in this category.

In addition, the ACIP includes ex-officio members from Federal agencies involved with vaccine issues, and non-voting liaison representatives from medical and professional societies and organizations. [cite web |title= ACIP members |date=2007-01-07 |accessdate=2008-01-31 |url=http://cdc.gov/vaccines/recs/ACIP/members.htm |publisher= National Center for Immunization and Respiratory Diseases]

Conflict of interest waivers

Most ACIP members, if not all, have ties to vaccine makers, such that the CDC must grant them waivers from statutory conflict of interest rules.Fact|date=January 2008 This professional experience contributes toward the development of their immunization expertise, and is the rationale offered by the CDC to justify waivers. The United States Congress has accepted this justification for service on federal advisory committees by experts with conflicts, and has provided for waivers from such prohibitions, under 18 USC § 208, when the need for the individual's service outweighs the potential for a conflict of interest.

Examples of ACIP conflict of interest issues:
* Advisory committee members own patents for vaccines under consideration.Fact|date=January 2008
* The CDC grants conflict of interest waivers to every ACIP member.Fact|date=January 2008
* Former committee chair, Dr. John Moldin, owned stock in Merck & Co.Fact|date=January 2008

Criticism

Vaccination critics believe that ACIP's crowded immunization schedule is unsafe. They have expressed concerns that "vaccine overloads" may cause serious side effects because of an excessive burden on the 'immature' immune systems of children.Fact|date=January 2008

The Advisory Committee attracted attention in 2006, when it was reported that it might not approve an effective vaccine against HPV, the human papillomavirus. HPV is a sexually transmitted disease that affects more than half of all Americans at some point in their lives. The virus directly leads to cervical cancer, killer of almost 5000 American women each year. Health officials affiliated with the Bush administration, as well as many conservative and Christian groups, claimed that inoculation of teenage girls against a sexually transmitted disease could encourage them to become sexually active. ACIP member Dr. Reginald Finger was quoted in the press as stating that, should an HIV vaccine become available, ACIP would have to carefully consider its effects on sexual activity.Fact|date=January 2008

ee also

* Joint Committee on Vaccination and Immunisation, the National Health Service counterpart in the United Kingdom

References

External links

* [http://cdc.gov/vaccines/recs/acip/default.htm ACIP home page]