Science for vaccine policy: Lack of transparency, misinformation, and poor decision processes at the December 2025 ACIP meeting

Abstract

Background: Vaccine policy has great urgency as infectious disease are resurgent. To understand the health of US vaccine policymaking, this report provides a comprehensive analysis of the Advisory Committee on Immunization Practices' (ACIP) December 2025 meeting.

Methods: We conducted a thematic analysis of pre-meeting public comments. We characterize the meeting's topics. We systematically compared the transparency of ACIP meetings before and after its members were replaced in June 2025. We characterized the accuracy of meeting comments based on analyses by the Evidence Collective. For the hepatitis B vaccine votes, we summarized evidence presented and analyzed committee processes and recommendations.

Results: Most pre-meeting public comments were from experts and health organizations supporting the universal birth dose of hepatitis B vaccine and explaining its safety and benefits. The meeting addressed few topics (2 vs. the usual 9+ topics). The meeting had low transparency, with an overall score of 53% (well below the 97% score for the October 2024 meeting). Presentations and comments by ACIP members contained over 60 instances of substantial misinformation. The hepatitis B vaccine discussions failed to use an Evidence to Recommendations Framework analysis and reflected inadequate preparation, disorganization, and misinterpretations of epidemiological data to suit a seemingly predetermined policy position. The resulting recommendation to remove the birth dose lacked supporting evidence and is likely to increase rates of hepatitis B infection and associated disease.

Conclusions: The quality of ACIP deliberations continues to degrade, and its policy recommendations are likely harmful to public health.

Keywords: Birth dose; Hepatitis B; Pediatric; Primary care; Safety; Vaccination.