For the past few years, Spokane family physician Gretchen LaSalle has participated in a Centers for Disease Control and Prevention workgroup determining national RSV vaccine policy.
The MultiCare Rockwood Clinic physician has not heard from the federal agency since June.
"I'm not sure if I am part of that workgroup. No one has told me I'm not. I don't know where that stands. I have not heard anything," she said .
Within the CDC vaccine approval process, the Advisory Committee on Immunization Practices meets several times each year to vote on vaccine recommendations that are ultimately approved by the agency as a whole.
LaSalle was not a member of ACIP. She served on one of the committee's many workgroups that focus on specific vaccines. These subcommittees are made up of people from a wide variety of backgrounds and specialty interests related to the vaccine at hand. LaSalle represented the American Academy of Family Physicians, which advocates for the interests of the medical specialty, on the respiratory syncytial virus subgroup.
The previously mundane work of the subcommittee was interrupted in June when Health Secretary Robert Kennedy Jr. replaced all 17 voting members of ACIP. Since then, the RSV workgroup has not met.
"Everything about this is highly unusual. My entire time, we met at least once or twice a month. We deliberated over the RSV vaccine. Who should be getting them? Are they cost effective? What's the safety? All the things that you would want someone making vaccine decisions to be thinking about. None of that work is happening now," she said.
The workgroup would prepare statements for the full ACIP committee giving all the pros and cons about any specific decision. Without this work, LaSalle is concerned rollout of an RSV vaccine booster will be delayed.
Like the flu and COVID-19, respiratory syncytial virus has similar symptoms of fever, coughing, wheezing, runny nose, shortness of breath and a decreased appetite. These symptoms tend to be mild and resolve within one to two weeks without medical intervention, but the disease carries the risk for serious symptoms - especially among infants and the elderly.
If an individual develops severe complications from RSV, they are likely to develop an infection of the lungs or inflammation of the small airways in the lungs. RSV is the leading cause of these symptoms, pneumonia and bronchiolitis among children younger than a year old.
RSV can also present serious risk to older adults and adults who are immunocompromised. According to CDC data, approximately 60,000 to 160,000 adults in the United States are hospitalized with RSV each year and 6,000 to 10,000 of those patients die because of complications of the virus.
Approval for an RSV vaccine arrived in 2023 and only for adults 60 and older. The RSV vaccine currently is administered once, but LaSalle and her colleagues had been working on possible approval of an optional booster .
In August, representatives of some physician advocacy organizations received an unsigned email from the CDC saying their input was no longer needed in the ACIP process. Groups that received this message include the American Medical Association, the American Academy of Pediatrics and the Infectious Diseases Society of America.
LaSalle did not receive any such notice, but she has still been shut out of any ACIP proceedings, and she said any inquiries to the CDC have been unanswered.
Since Kennedy's dismissal of the original ACIP, newly appointed members met for the first time in September. The new committee narrowly rejected proposals to require a prescription to receive the COVID vaccine. The panel also removed a recommendation for the combined MMR and varicella - or chickenpox - vaccine for infants, instead endorsing separate MMR and chickenpox vaccines.
Support staff for the committee has been laid off amid the ongoing government shutdown, and another ACIP meeting scheduled in October was cancelled.
Asked about the September meeting, LaSalle said it was unlike any ACIP meeting she had ever viewed and that the new members "did not follow any usual protocol."
"The decisions that are being made are just not being made based on scientifically rigorous information. They're more a preconceived notion that many of the people now sitting on the committee have. They're looking for data to try to support a preconceived notion, instead of looking to see what the data really says itself," she said.
Asked if the public should trust vaccine recommendations from the CDC or ACIP, LaSalle said she was unsure.
"These really highly trusted organizations that have become the model for other public health programs around the world are being torn down, and trust is being eroded in those organizations," she said.
LaSalle recommends the public follows vaccine recommendations made by Washington state.