A federal advisory committee that influences how vaccines are given and distributed in the U.S. narrowly avoided making drastic changes to pediatric and COVID-19 vaccinations.

The Advisory Committee on Immunization Practices voted 7-6 on Friday against a recommendation that people in all age groups get a prescription before obtaining an updated COVID-19 vaccine. Also on Friday, the committee voted to indefinitely postpone a vote that would have changed when the hepatitis B vaccine is given from shortly after birth to one month after birth.

The COVID-19 proposal considered by the committee would have advised state and local health agencies to require a prescription for the vaccine — guidance that could have had a significant impact in Maine, if approved. In 19 states, including Maine, pharmacists must follow ACIP guidance and can’t administer vaccines that go against the committee’s recommendation.

During the committee presentation, groups representing pharmacists pointed out that 90% of COVID-19 vaccinations are administered at pharmacies.

Immunizations don’t typically require a prescription.

Dr. Laura Blaisdell, a Portland pediatrician and immediate past president of the Maine chapter of the American Academy of Pediatrics, said she’s glad that some of the proposed measures weren’t taken on Friday, but it’s little comfort considering how close the vote was to denying vaccine access to many.

“We’re watching incompetence in action,” Blaisdell said. “This committee does not understand how vaccines are approved, evaluated, supplied, paid for and utilized.”

Dr. Amy Middleman, an ACIP committee member who voted against the COVID-19 prescription recommendation, said during the meeting that requiring prescriptions for the vaccines would “overwhelm” doctor’s offices in an already strained primary care system.

Robert F. Kennedy Jr., the Trump administration’s health and human services secretary and an anti-vaccine activist, revamped the ACIP committee this year, packing it with vaccine critics.

The committee took three other votes on Friday revolving around advice to physicians on what to tell patients about the risks and benefits of getting the COVID-19 vaccine.

Blaisdell said she doesn’t believe those committee votes will have much of an impact, because doctors already have these discussions with their patients.

On Aug. 27, the Food and Drug Administration only approved the COVID-19 vaccine for those 65 and older and those with high-risk conditions, including diabetes, obesity, physical inactivity and mental health issues. But Maine, like several other states, has issued an executive order preserving COVID-19 access for everyone.

What the conflicting order and recommendations will mean for patients trying to get a COVID-19 shot was unclear on Friday.

John Porter, a MaineHealth spokesperson, said on Friday that “our clinical and operational leaders will be meeting early next week to discuss the latest recommendations” and that “we will subsequently share this information with our patients and the broader community.”

On Thursday and in another vote on Friday morning, the committee also voted to restrict access to the combined MMRV vaccine, which stands for measles, mumps, rubella and varicella (chickenpox). The vote stops the federal Vaccines for Children program, which distributes free vaccines to millions of lower-income children nationwide, from giving the MMRV vaccine for free to children under age 4.

Vaccines for Children will instead administer the MMR and varicella vaccines separately. While that will provide the same level of coverage, Blaisdell said she’s worried about vaccine supply.

Vaccine manufacturers produced the MMRV vaccine, MMR and varicella vaccines anticipating that all of them would be available. If MMRV is restricted, there may be too much demand for the supply of the MMR and varicella vaccines, she said.

“What if states don’t receive enough vaccine supplies for our kids?” Blaisdell said. “We are talking about potential shortages in MMR and varicella vaccines at a time when we are having massive outbreaks of measles.”

Dr. Noah Nesin, a board member at the Maine Public Health Association and a family doctor in Bangor, said confusion about the safety of vaccines driven by scientists and experts on the ACIP committee could threaten vaccine uptake in Maine. 

“The uncertainty that it creates around all of these vaccines that they’re debating (Thursday and Friday) is just going to put more people at risk, because it’s going to increase vaccine hesitancy among our population,” he said. “And it’s going to increase barriers to getting vaccines, even for people who want it.”

Also on Thursday, the Northeast Public Health Collaborative announced its official formation. The collaborative — which includes Maine, Connecticut, New York, New Jersey, Massachusetts, Pennsylvania, Rhode Island and New York City — aims to coordinate public health efforts in the region. The collaborative was formed in response to attacks on public health by the Trump administration and one of its goals is to preserve access to vaccines.

Gov. Janet Mills said in a written statement Thursday: “As the Trump administration politicizes and undermines our nation’s public health system, our state will work closely with our neighbors to promote and protect the health and wellbeing of Maine people.”