The measles, mumps and rubella (MMR) vaccine is undergoing more scrutiny by the Trump administration in their ongoing reassessment of vaccines despite the worst measles outbreak in decades.
Jim O’Neill, the deputy secretary of the US Department of Health and Human Services (HHS) and the acting director of the US Centers for Disease Control and Prevention (CDC), called on Monday for new vaccines to replace the current MMR shots.
“I call on vaccine manufacturers to develop safe monovalent vaccines to replace the combined MMR and ‘break up the MMR shot into three totally separate shots,’” O’Neil wrote in a post on X/Twitter.
He quoted a post from Donald Trump on 26 September urging against the use of Tylenol and “mixed” vaccines, as well as delaying hepatitis B vaccination from birth until 12 years of age.
Many of the vaccines in the routine childhood immunization schedule are combined in order to reduce the number of shots children receive, and their safety and efficacy have been demonstrated by decades of research.
Breaking up the vaccines “would be a remarkably complicated, time-consuming, costly, but more importantly unnecessary action”, said Jason Schwartz, an associate professor at the Yale School of Public Health.
Adding more shots to the schedule would make it more expensive to vaccinate children, and they would need more visits with pediatricians to receive the shots. If all childhood immunizations were given separately, it would take 20 visits to get a six-month-old fully vaccinated.
“The more visits, the more appointments, the more follow-up doses that are required, parents – given that lives are complicated and vaccine schedules are complicated – will be less likely to complete all the additional appointments or follow-up visits required,” Schwartz said. “Splitting up will mean that fewer kids will complete the MMR series.”
Breaking them up “serves no purpose”, said Paul Offit, director of the Vaccine Education Center at Children’s Hospital of Philadelphia and the co-inventor of a rotavirus vaccine. “We’re already talking about difficulties in affording all of this.”
Some vaccines, like the diphtheria, tetanus and pertussis (DTaP) shot, are only made together and cannot be broken up. While separate vaccines for measles, mumps and rubella were licensed in the 1960s, only the combined MMR shots are now available for use in the United States.
The current MMR shots in the US are made by Merck and GSK. Both companies have said there is no published scientific evidence to support separating the vaccines, and the combination vaccines play an important role in making vaccination easy and inexpensive. Releasing separate vaccines now would require entirely new saline placebo-controlled clinical trials under new Trump administration policies – an “unimaginable” process when safe and effective vaccines already exist, Schwartz said.
Even if manufacturers were able to create new trials for separate vaccines, it would be “incredibly unethical” to conduct them, said Angela Rasmussen, a virologist at the Vaccine and Infectious Disease Organization at the University of Saskatchewan.
“You would be exposing, basically, infants to potentially lethal diseases,” she said. No ethics and regulatory board would approve such a trial, and providers and families are unlikely to participate, she added. “Those trials won’t happen.”
There was another meeting of the CDC’s advisory committee on immunization practices (ACIP) planned for 22-23 October. It has been indefinitely postponed.
“It’s anyone’s guess,” Schwartz said. The ACIP could say they would like to see monovalent vaccines, but there are no monovalent vaccines approved for them to recommend, he said.
At the meeting in September, the independent advisers began a discussion of delaying the hepatitis B vaccine, the first of which is currently recommended at birth, but they tabled the discussion.
Young children usually receive later hepatitis B doses as part of combination shots – so if that recommendation is changed, the combination vaccines would be affected.
Offit has “no idea” what the vaccine advisers might discuss, he said. “These people are not making decisions based on scientific data, they’re making decisions based on their own sort of anti-vaccine notions – so who knows. Anything can happen.”
But, he said, discussions about breaking up MMR specifically were asked and answered by the ACIP more than two decades ago.
Offit served on the ACIP from 1998 to 2003, during which time the now-retracted study led by Andrew Wakefield was published and gained attention.
Wakefield claimed without evidence in the study that there was a potential link too autism between “the combined measles, mumps, and rubella vaccine (rather than monovalent measles vaccine)”.
A year before the study was published, Wakefield had filed a patent application for a monovalent measles vaccine, though he did not disclose this conflict of interest in the study.
Wakefield argued that the combination shot weakened the immune system and created cascading effects that led to autism. “We had no evidence for any of this,” Offit said.
The ACIP held a vote on changing the MMR vaccine recommendation soon after the study was published.
“We obviously all voted no, because there was no evidence that MMR caused autism,” Offit said. There were already epidemiological studies at that time showing no relationship between being autistic and getting vaccinated.
In September, the ACIP voted to remove the recommendation for the combination MMR and varicella (chickenpox) vaccine, a move that was officially adopted by the CDC last week. The changes are already creating confusion among patients and pediatric offices.
“Let’s not underestimate just how damaging complexity and confusion are for vaccination efforts, for both patients and families and healthcare providers,” Schwartz said.
Making the process more confusing, expensive and time-consuming is another way to keep kids from being vaccinated, Rasmussen said.
“By making many of these vaccines monovalent, that’s going to actually just remove access to them, and there won’t be any vaccines at all,” she continued. “Those vaccines will probably still get made, but if a vaccine is sitting on a shelf and not going into somebody’s arm, then it’s worthless, essentially. I think anti-vaxxers love vaccines that sit on shelves.”
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