A member of a key US vaccines advisory panel has drawn criticism after describing vaccination recommendations as coercive and likening them to “medical battery”, despite vaccines being voluntary at the federal level.
In an article for the New York Times, Milhoan argued that vaccine guidance leaves families with “no choice”. However, the US government has never mandated childhood vaccinations nationwide. Instead, the Advisory Committee on Immunization Practices (ACIP) issues evidence-based recommendations, which the Centers for Disease Control and Prevention (CDC) may choose to adopt.
On a recent podcast, Milhoan appeared to misrepresent the committee’s role, saying: “We make a recommendation, CDC has to basically canonise it.” In practice, the CDC is not obliged to follow ACIP advice.
Milhoan said the committee had recently altered recommendations due to concerns that mandates had increased vaccine hesitancy. He criticised previous panels for what he described as “heavy-handed” and “authoritarian” guidance that he said led to mandates.
Experts say the argument misunderstands how vaccine policy works in the United States. Dr Schwartz said current ACIP members appear to view even recommending vaccines as an infringement on parental freedom, despite that being the committee’s remit for decades.
He compared the claim to suggesting that national dietary guidelines infringe on freedom of food choice.
Vaccination requirements for schools are set by states and local authorities, not by the ACIP or CDC. Schwartz said changes usually involve lengthy processes through health departments and, in many cases, legislation.
“The idea that states simply rubber-stamp CDC recommendations into mandates does not reflect reality,” he said. Several vaccines recommended by the CDC, including influenza, rotavirus and HPV, are rarely required for school attendance.
While some states previously relied on federal guidance when setting requirements, that link has weakened. A new report by the health policy group KFF found that most states are now separating school mandates from federal recommendations.
All states allow medical exemptions from school vaccination requirements, and some permit philosophical exemptions. Researchers warn that the growth of such exemptions increases the risk of outbreaks.
On the podcast, Milhoan said he wanted to promote “medical freedom”. Public health experts argue that this approach could undermine broader freedoms.
Schwartz questioned the rights of vaccinated children to attend schools and public spaces without increased risk, as well as the safety of children who cannot be vaccinated for medical reasons.
Dr Jacobs said medical freedom also includes the right not to be exposed to potentially fatal infectious diseases. He noted that the vast majority of families support vaccination.
Milhoan also raised concerns that repeated vaccination could overstimulate the immune system and suggested links to allergies, asthma and eczema, claims experts say are not supported by decades of research.
He rejected the idea of “established science”, saying safety could only be observed, not proven. Scientists counter that observation is only the first step in rigorous research.
“Established science is why we have been able to hold vaccine-preventable diseases at bay,” Jacobs said.
The next ACIP meeting is scheduled for February. Schwartz said he expected the committee to continue questioning the benefits of vaccines and narrowing federal recommendations.
As a result, he said, guidance from medical organisations, state health officials and new regional alliances will become increasingly important in shaping public health policy.
