Worth a Shot: How ACIP Changes Are Reshaping US Vaccine Policy

Gretchen Garofoli, PharmD, BCACP, warns that rapid, politically driven changes to the nation’s vaccine advisory process have created confusion for providers and patients and could erode trust in immunization policy.

Garofoli, a clinical professor in the School of Pharmacy at West Virginia University, spoke on the Worth a Shot podcast about the upheaval surrounding the Advisory Committee on Immunization Practices (ACIP) and its ripple effects across public health, pharmacy practice, and insurance coverage.

She began by outlining ACIP’s traditional role as developing evidence-based recommendations for US immunizations, including who should receive vaccines, the number and timing of doses, and any precautions or contraindications.

“The role of ACIP…is to develop recommendations for US immunizations licensed by the FDA,” she explained, noting that these recommendations were historically approved by the CDC director, published in the Morbidity and Mortality Weekly Report, and then added to the immunization schedule.

That long-standing process, built on expert review and public input, began to unravel in 2025. In June 2025, 17 ACIP members were dismissed and quickly replaced through a dramatically shortened vetting process. Garofoli emphasized why that matters.

“There needs to be a structure in place with checks and balances…we don’t just have one person making recommendations or changes,” Garofoli said. The original ACIP framework, she said, ensured that “experts in the field were making the recommendations” with opportunities for public comment.

As ACIP’s composition and decisions shifted, many states and regional coalitions began turning elsewhere for guidance. Garofoli noted that numerous jurisdictions “have guidelines that are no longer aligned with ACIP,” pushing them to look instead to the American Academy of Pediatrics (AAP), the American College of Obstetricians and Gynecologists (ACOG), and the American Academy of Family Physicians (AAFP).

“Again, like I said, it’s made it confusing for patients and providers alike,” she said.

Some of ACIP’s new moves have reignited long-settled controversies. In 2025, the committee voted to remove thimerosal-containing influenza vaccines from recommendations for children, pregnant women, and adults—despite the fact that nearly all flu vaccines were already thimerosal-free. Garofoli stressed that “not really much had changed because it really didn’t impact a lot of vaccines,” but the decision “just caused a lot of discussion amongst providers and patients.”

Amid renewed public anxiety about vaccines and autism, Garofoli underscored the pharmacist’s responsibility to respond with both empathy and evidence.

“Pharmacists first and foremost need to be empathetic,” she said. “We need to listen to our patients, and we need to understand where they’re coming from.” She emphasized that “the link between vaccines and autism has not been substantiated through years and years and years of research,” but that dismissing concerns is not an option. “We never want to brush off a patient and their concerns…Pharmacists are among the most trusted health care practitioners, so we need to be there for our patients,” she added.

Garofoli also highlighted the growing role of shared clinical decision-making for certain vaccines, such as meningococcal B, HPV in adults 27 to 45 years, and select pneumococcal and hepatitis B vaccinations. In these cases, decisions are tailored to the individual rather than made as universal recommendations. She described it as “an individual-based decision process between a healthcare provider and that patient or the parent or guardian” in which clinicians weigh “the best available evidence,” patient characteristics, and values.

Legal challenges have further complicated the landscape. A federal court’s preliminary injunction blocked the revised 2026 childhood immunization schedule, citing flaws in how the reconstituted ACIP was formed and how the CDC bypassed its traditional processes. Garofoli said the lawsuit underscores why “checks and balances…are there for a reason to ensure that the process is being followed.”

Looking ahead, she cautioned that uncertainty around ACIP meetings and schedules—especially for the critical respiratory season—demands vigilance from pharmacists. With federal guidance in flux, she urged practitioners to consult their state practice acts and trusted professional organizations to ensure they are following both the law and the best available science.