The Centers for Disease Control and Prevention is poised to no longer recommend a particular form of vaccine against measles, mumps, rubella, and chickenpox, which will have sweeping implications for insurance coverage.

Members of the CDC’s Advisory Committee on Immunization Practices indicated at a meeting on Thursday that they are likely to decide that the less commonly used combined vaccine against measles, mumps, rubella, and varicella, commonly known as the MMRV vaccine, should not be given to children under age four due to heightened seizure risk. 

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ACIP’s decision would not affect insurance coverage of the two-shot combo of MMR and the separate varicella vaccine, called MMR+V, which is used by 85% of parents who choose to vaccinate their children at the 12- or 15-month infant well visits.

The review of the MMRV vaccine comes amid significant political controversy at the CDC, which was sparked after Health and Human Services Secretary Robert F. Kennedy Jr. fired the agency’s director, Susan Monarez. 

Monarez told the Senate during an oversight hearing that Kennedy fired her in August because she refused to “preapprove” decisions on the childhood vaccine schedule to be made during the ACIP meeting on Thursday and Friday.  

ACIP’s decision to no longer recommend the MMRV vaccine would mean it is no longer covered by the federal Vaccines for Children Program, which provides vaccines to low-income families. It would also prevent Medicaid and Children’s Health Insurance Program coverage for the MMRV vaccine.

Only 15% of parents choose to use the single-shot MMRV vaccine, usually because they prefer their child to have fewer injections.

More parents choose to use the MMR+V vaccine because of the risks associated with the MMRV shot, as laid out by the CDC in their 2009 guidance on the issue, documenting higher rates of febrile seizures, or seizures due to fever.

CDC career scientists said at the ACIP panel on Thursday that “the risk is slightly higher with MMRV combination vaccine after the first dose” at either the 12-month or 15-month infant wellness visit.

Roughly 2% to 5% of children have at least one febrile seizure before age 4, most occurring between 14 and 18 months. Seizures can last up to 15 minutes, typically resulting in an emergency room visit.

Much of the committee’s discussion leading up to the vote on the measure concerned the ripple effects that adverse consequences can have on the parents of children who experience side effects.

Dr. Kirk Milhoan, a pediatric cardiologist newly appointed to ACIP, said during discussions that 15 minutes “is an enormously long time for a child to seize” and that the experience makes it more difficult for clinicians and parents to willingly vaccinate a child again for any disease.

“I think there’s an increased hesitancy through all families right now, and I think that that’s what we’re here to do, is try to give them the best risks, benefits of these things as we can,” said Milhoan. 

When discussing vaccine hesitancy, ACIP chair Dr. Martin Kulldorf said that hesitant parents might benefit from only needing one shot for their children, but that benefit could be outweighed by the fear of vaccines sparked by a febrile seizure event.

“In one way, children don’t like needles, so fewer needles might mean that it’s more likely that they get vaccines,” Kulldorf said. “But also, if there’s adverse reactions to vaccines, then that can create questions about vaccines, not only among the parents, but siblings or neighbors or cousins.”

Non-voting liaisons to ACIP from medical professional organizations pushed back on the move to no longer recommend the MMRV shot, saying that it will create health equity concerns.

Dr. Jason Goldman of the American College of Physicians said the recommendation would “create more confusion among the public” and take away parents’ choices.

“When you make this recommendation, you now give license to insurance companies and the Vaccines For Children program not to give this vaccine, and finally, you are taking away the choice of parents to have informed consent and discussion with their physician on what they want to do for the health and benefit of their children,” said Goldman.