Policies Procedures 508

Advisory Committee on Immunization
Practices Policies and Procedures

June 2022

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Contents
Introduction  ................................ ................................ ................................ ................................ ..................  1
Organization of this Document  ................................ ................................ ................................ .................  1
ACIP Structure  ................................ ................................ ................................ ................................ ...............  1
Charge to Members  ................................ ................................ ................................ ................................ .. 1
Member Types  ................................ ................................ ................................ ................................ ..........  2
Voting Members  ................................ ................................ ................................ ................................ ... 2
Ex Officio  and Liaison Members  ................................ ................................ ................................ ............  3
ACIP Leadership  ................................ ................................ ................................ ................................ ........  3
Chairmanship a nd Vice Chairmanship  ................................ ................................ ................................ .. 3
ACIP Secretariat and Steering Committee  ................................ ................................ ............................  3
Work Groups  ................................ ................................ ................................ ................................ .............  4
ACIP Functions  ................................ ................................ ................................ ................................ ..............  4
Process for Developing Recommendations  ................................ ................................ ..............................  5
Technical Aspects  ................................ ................................ ................................ ................................ .. 5
Developing the Recommendations  ................................ ................................ ................................ .......  5
Meetings  ................................ ................................ ................................ ................................ ...................  7
Selection of Topics  ................................ ................................ ................................ ................................  7
Voting  ................................ ................................ ................................ ................................ ....................  7
Internal Decision Memos  ................................ ................................ ................................ ......................  8
Publication of Recommendations  ................................ ................................ ................................ .........  9
Implementation and Evaluation of the Recommendations  ................................ ................................ .. 9
Public Comment  ................................ ................................ ................................ ................................ .... 9
Rules of Conduct for ACIP Meetings  ................................ ................................ ................................ ... 10
Electronic Recording by Public Media  ................................ ................................ ................................ . 11
ACIP Recommendations for the Vaccines for Children (VFC) Program  ................................ ..................  11
Member Roles and Responsibilities  ................................ ................................ ................................ ............  11
General Member Responsibilities  ................................ ................................ ................................ ...........  11
Attendance at Meetings  ................................ ................................ ................................ .....................  11

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  ACIP -Related Contacts  ................................ ................................ ................................ ........................  12
Media Interactio n ................................ ................................ ................................ ...............................  12
Committee Correspondence  ................................ ................................ ................................ ...............  13
Responsibilities Specific to Member Roles  ................................ ................................ .............................  13
Chair  ................................ ................................ ................................ ................................ ....................  13
Vice Chair  ................................ ................................ ................................ ................................ ............  14
Voting Members (including Chair an d Vice Chair)  ................................ ................................ ..............  14
Conflicts of Interest when Participating as a Member  ................................ ................................ ...........  14
Membership Policies and Procedures  ................................ ................................ ................................ ........  16
Voting Members  ................................ ................................ ................................ ................................ ..... 16
Appointments a nd Tenure  ................................ ................................ ................................ ......................  16
New Members ................................ ................................ ................................ ................................ .........  16
Membership Qualifications  ................................ ................................ ................................ .................  16
Solicitation for Nominees ................................ ................................ ................................ ....................  16
Selection of Nominees  ................................ ................................ ................................ ........................  16
Notification to Applicants  ................................ ................................ ................................ ...................  17
Consideration for Nomination: Financial Conflicts of Interest  ................................ ...........................  17
Orientation and Education  ................................ ................................ ................................ ......................  18
Table. ACIP Membership (as of October 2017)  ................................ ................................ ..........................  19
Appendix. Member Conflicts of Interest and Financial  Interests  ................................ ...............................  21

1
 Introduction
The Advisory Committee on Immunization Practices (ACIP) is a  federal advisory committee, composed  of
medical and public health experts , that provides advice and guidance to the Director of the  Centers for Disease
Control and Prevention (CDC)  on the most effective means to prevent vaccine -preventable diseases  in the
United States . ACIP’s  guidance includes  the use of vaccines , and may  also include recommendations for
administration of immune globulin preparations and/or antimicrobial therapy shown to be effective in
controlling a disease for which a vaccine is available.  In addition, ACIP has a statutory authority for the Vaccines
for Children (VFC) program; ACIP has sole responsibility and authority to determine the vaccines, number of
doses, sched ule and contraindications for the VFC program.
ACIP develops written recommendations —subject to the approval of the  CDC Director —for the routine
administration of vaccines to  both  pediatric and adult populations. To inform its advice to the CDC Director, ACIP
considers disease epidemiology and burden of disease, vaccine efficacy and effectiveness, vaccine safety, the
quality of evidence reviewed, economic analyses , and implementati on issues. The overall goals of ACIP are to
provide advice that will assist CDC and HHS in reducing the incidence of vaccine preventable diseases  and to
increase the safe usage of vaccines and related biological products, including active and passive
immun oprophylaxis. The target populations for ACIP recommendations are public and private health care
providers who administer vaccines, public and private officials who make vaccine policy, and the general public.
Organization of this Document
This document is  intended to serve as a reference for ACIP members (and interested members of the general
public ) about ACIP’s structure and functions. It is organized into the following sections:
• ACIP Structure : This section describes the individuals and groups who make up ACIP.
• ACIP Functions : This section provides an overview of the activities and objectives of ACIP.
• ACIP Roles and Responsibilities : This section contains descriptions of the roles and responsibilities of
ACIP members in carrying out ACIP’s functions.
• ACIP Membership Procedures: This section details the process for nomination, selection, and orientation
of new ACIP members.
ACIP Structure
ACIP is a Federal Advisory Committee; t he Federal Advisory Committee Act of 1972 requires all such committees
to have a committee charter.  The charter marks the formal establishment of the committee , and t he language of
the charter specifies the committee’s mission or charge and includes operat ional characteristics, such as the
number of members and the types of expertise required, the number of meetings to be held per year, and the
projected yearly operating cost for the committee.  Any proposed changes to the charter are discussed by the
Steeri ng Committee.  The ACIP Secretariat is responsible for renewing the charter every 2 years, and submitting
amendments  to the Secretary of Health and Human Services, who is responsible for reviewing and approving the
charter renewal .
ACIP ’s charter is availa ble at https://www.cdc.gov/vaccines/acip/committee/charter.html .
Charge to Members
Within ACIP’s charter, the formal Objective and Scope of Activities  are:

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 “The Secretary, Department of Health and Human Services (HHS), and by delegation the
Director, Centers for Disease Control and Prevention (CDC), are authorized under Section 311 and
Section 317 of the Public Health Service Act, [42 U.S.C. §243 and 42 U.S.C. §247b], as ame nded,
to assist states and their political subdivisions in the prevention and control of communicable
diseases; to advise the states on matters relating to the preservation and improvement of the
public’s health; and to make grants to states and, in consul tation with the state health
authorities, to agencies and political subdivisions of states to assist in meeting the costs of
communicable disease control programs.”
Members of ACIP have a responsibility to provide CDC and HHS with high  quality , well consid ered advice and
recommendations . ACIP m embers play a critical role in ensuring the reputation of ACIP as a nationally and
internationally recognized advisory group in the field of immunization. ACIP members are committed to the
development and improvement of public health policies.
Member Types
ACIP comprises up to 20  voting members, eight ex officio  members, and 3 1 liaison representatives ( see the
Table) , who function under  a Chair and Vice Chair and are guided by a Steering Committee .
ACIP Membership must include at least 20% minority representation. The following is the official description of
qualifying U.S. minority group candidates provided by Federal Advisory Committee Management Branch
(FACMB )/Management Analysis and Services Office  (MASO ):
• Black or African American
• Hispanic
• American Indian/Alaska native
• Asian ( origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent
including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, th e Philippine Islands,
Thailand, and Vietnam. It includes “Asian Indian, ” “Chinese ,” “Filipino ,” “Korean ,” “Japanese ,”
“Vietnamese ,” and “Other Asian .”)
Voting Members
Voting members serve overlapping terms of 4 years . Voting members  are identified by the ACIP Steering
Committee, and selected and appointed by the Secretary  of HHS . Members fall into the following two
categories:
• Medical Professional Members ( up to 19). ACIP includes up to 19  members representing clinical
medical fields (physician, nurse, nurse practitioner) and/or public health professionals, e.g., State Health
Department  staff or  epidemiologist s. These positions are held by technically qualified people trained in a
clinical medical field who  possess in -depth knowledge of vaccines and immunization. Candidates for this
position may be recommended by a professional medical organization or other interested parties. ACIP
also welcomes self -nominated candidates possessing the requi red technical knowledge and experience.
• Lay Member: Consumer Representative (one) . ACIP must include a consumer representative as one of
the 15 voting members of the committee. This position is held by a technically qualified person
knowledgeable about co nsumer perspectives and/or social and community aspects of immunization
programs. Candidates for this position may be recommended by a consortium of consumer -oriented

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 organizations, an individual consumer -oriented organization, or other interested parties.  ACIP also
welcomes self -nominated candidates possessing the required technical knowledge and experience.
Ex Officio  and Liaison Members
In addition to the voting members, the Committee has  eight  ex officio  members (who generally do not vote, but
may be designated to vote in specific circumstances by the Executive Secretary) from other federal agencies and
31 non-voting liaison representatives from professional societies and organizations responsible for the
development and execution of immunization programs for children and adults.  Ex officio  members and liaison
representatives are expected to represent the position and views of their sponsoring organizations , and to
contribute to Committee discussions when issues of importance to their organization are being discussed and
when they possess information important to the discussion . Ex officio  and liaison members  also may serve o n
Work Groups to provide expert advice and apprise the Work Group of the position t heir organization endorses.
Ex officio  members representing (and financially supported by) other federal agencies/ departments are
appointed based on a written document which outlines how the other agency/ department can contribute to the
quality of ACIP de liberations and decisions and/or enhance the implementation of ACIP recommendations.
Appointments of liaison representatives, primarily from professional organizations, are based upon written
requests from organizations which document the commitment of the  organization to providing expert input into
ACIP decision -making process, travel and per diem support to their representative, and strongly encouraging
their membership to adopt ACIP recommendations.  Because of space and time limitations at meetings, liai son
representatives must represent organizations that have broad immunization interests and that represent large
constituencies.  Groups that  represent more narrow interests (e.g., interest in a single disease or vaccine) or
small constituencies (e.g., orga n transplant patients) are invited to participate in ACIP activities on an ad hoc
basis whenever issues of interest and concern are being discussed rather than requesting liaison representation.
ACIP Leadership
Chairmanship and Vice Chairmanship
Every 3 years the ACIP Secretariat  identifies an ACIP Chair  from the ACIP member s who have served  at least one
year .  The ACIP Chair  serves a 3 -year term , as defined in ACIP Charter, and must be confirmed by the Secretary
of HHS when the nomination package is submitted for approval. The ACIP Secretariat  review s characteristics of
potential candidates, including leadership skills , a demonstrated ability to maintain  a smooth and timely
processing of agenda items and discussion by ACIP members and the public during ACIP meetings, and ability to
meet the other considerable demands placed on the Chair .
The ACIP Secretariat select s a voting member to serve as Vice  Chair of the Committee. This is not a position
formally described within ACIP charter, but this is quite often the person who will be invited  to be come  the next
Chair.
ACIP Secretariat and Steering Committee
The ACIP  Secretariat is composed of CDC staff members . The ACIP Executive Secretary, or “Designated
Federal Official,” (DFO) is a senior consultant to the Director of the National Center for Immunization and
Respiratory Diseases (NCIRD). The DFO is responsible for the committee's overall management an d
compliance with FACA law.

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 Steering Committee m ember s includes representatives from each of the major centers at CDC. Some  Steering
Committee members  are affiliates of Work Groups within ACIP.  The Steering Committee meets four times per
year : once before each ACIP meeting (February, June, and October ) to plan the meeting agenda and once in
November/December to discuss the nomination of new members.
Work Groups
ACIP utilizes subgroups of the Committee, or Work Groups, to extensively  review  relevant published and
unpublished data and develop recommendation options for presentation to the ACIP  during its public meetings .
ACIP  Work Groups 1) must include two or more ACIP voting members , one of whom serves as Chair ; 2) must
include CDC staff membe rs; 3) should include an FDA staff member , if appropriate ; and 4) may include ex officio
members and liaison representatives.  Only appointed ACIP voting members may chair a Work Group.  On
occasion, disease/vaccine experts who are not government employees, ACIP members, ex officio  members or
liaison representatives may be asked to serve as consultants to a Work Group.  Members with a potential
financial conflict of interest cannot serve on  a Work Group that  is dealing with a product that  is the subject of
the conflict.  If the individual has unique expertise to the Work Group, that person may serve as a scientific
consultant but should not participate in policy deliberations.  Conflict of int erest declarations are signed by Work
Group members annually and changes should be announced during Work Group teleconferences.
Representatives of vaccine manufacturers may not serve as members of a Work Group but, at the discretion of
the Chair, may be as ked to make presentations to the group and answer questions.  Following these
presentations, non -Work Group members may be asked to leave in order to allow deliberations to be limited to
members of the Work Group.
ACIP Work Groups accomplish most of their work through regular teleconferences.  These teleconferences
are closed  meetings, and therefore ACIP Work Groups must observe certain guidelines that allow them to
function exempt from FACA requirements.   As FACA -exempt groups, ACIP W ork Groups  are not al lowed
to render consensus advice or recommendations directly to  the Federal government. ACIP Work Group
Chairs, other Work Group  representatives, or the W ork Group s per se are not empowered to speak on
behalf of ACIP. Rather, they are utilized by ACIP to g ather and organize information upon which ACIP can
deliberate and act. Thus, while ACIP Work Groups  can and should examine specific topics in detail and
define the issues, including development of options for recommendations, the actual processes of group
deliberation terminating in development of immunization recommendations must occur in the open
public forum of ACIP meetings in compliance with FACA requirements. Additional information on ACIP
Work Groups and their functioning is available in the ACIP Wor k Group Standard Operating Procedures
document, which is available from the ACIP Secretariat.
ACIP Functions
Per its charter, ACIP’s primary duties are:
• Advising and guiding the Director of the CDC regarding use of vaccines and related agents for effectiv e
control of vaccine -preventable diseases in the civilian population of the United States.
Recommendations made by ACIP are reviewed by the CDC Director, and if adopted, are published as
official CDC/HHS recommendations in the Morbidity and Mortality Weekly Report  (MMWR ).

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 • Providing advice regarding the control of diseases for which a vaccine is licensed in the U.S. The
guidance will address use of vaccines and may include recommendations for administration of immune
globulin preparations and /or antimicrobial therapy shown to be effective in controlling a disease for
which a vaccine is available. The committee also may provide recommendations that address the
general use of vaccines and immune globulin preparations as a class of biologic agent s, use of specific
antibo dy products  for prevention of infectious diseases, and special si tuations or p opulations that m ay
warrant modi fication of the r outine rec ommendations .
• Establish ing and periodically review ing and, as appropriate, revis ing the list of vaccines for
administration to children and adolescents eligible to receive vaccines through the Vaccines for Children
Program, along with schedules regarding the appropr iate dose and dosing interval, and
contraindications to administration of the pediatric vaccines , in accordance with Section 1928 of the
Social Security Act .
The specific functions that support these duties are detailed below.
Process for Developing Recomm endations
Technical Aspects
ACIP Work Groups are formed to extensively  review  relevant published and unpublished data and develop
recommendation options for presentation to the ACIP  during its public meetings .  Additional information on
ACIP Work Groups an d their functioning is available in the ACIP Work Group Standard Operating Procedures
document, which is available from the ACIP Secretariat.
Work Group are formed when updates to existing recommendations are anticipated based on availability
of new data (regarding safety, effectiveness, and/or programmatic issues, e.g., vaccine administration or
storage), or licensure of a new vaccine or new indications for existing vaccines are anticipated. In general,
Work Group s should begin re viewing data 12 -18 months prior to a potential decision on licensure; the
length of time required for the W ork Group  to review data in anticipation of vaccine licensure will depend
upon the complexity of the topic and the amount of available data existing.  Immunoglobulin therapies
and/or antimicrobial agents may be considered by ACIP in relation to control of a disease for which there
is a vaccine available or under consideration.
Active Work Groups review recommendations regularly.  For vaccines for which there is not a Work Group, the
recommendations should be reviewed on a regular basis, at least every 7 years , and either revised, renewed, or
retired  with a vote by ACIP . A Work Group may or may not be established for this review, depending on whether
minor or major changes to the recommendations are needed.  However, a summary of any minor changes to the
recommendations is presented to ACIP and voted on and published in the MMWR . The adult schedule, child and
adolescent schedule, and influenza recommendations are published in the MMWR  annually.
All Work Group findings generally are presented to ACIP in an open meeting, and this information is then
deliberated.  ACIP Work Groups are u sed as a resource for gathering, analyzing, and preparing information for
the Committee that  will discuss and deliberate on the information presented .
Developing the Recommendations
Recommendations are subject to extensive review by  ACIP members,  staff o f the CDC  and FDA, outside expert
consultants, and vaccine manufacturers.

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 CDC vaccine recommendations are developed using an explicit evidence -based method based on the Grading of
Recommendations, Assessment, Development and Evaluation (GRADE) approach. Ke y factors considered in
development of recommendations include the balance of benefits and harms, type or quality of evidence, values
and preferences of the people affected, implementation issues (excluding issues around payment and program
costs) and heal th economic analyses . More information about GRADE can be found in the ACIP’s GRADE
handbook ( https://www.cdc.gov/vaccines/acip/recs/grade/downloads/handbook.pdf ).
Most is sues that ACIP will vote upon require a GRADE evaluation of the evidence. However, a “when to GRADE”
algorithm is currently under development and once it is finalized a link will be added here. A summary of the
GRADE evidence should be included in the MMWR  Policy Note, and the GRADE evidence tables are published on
the ACIP website ( https://www.cdc.gov/vaccines/acip/recs/grade/table -refs.html ). If it is determined that a
GRADE eval uation is not needed, the rationale for why GRADE is not being done will be clearly documented. The
ACIP Secretariat is available to assist with questions about GRADE.
Additionally, the ACIP is currently evaluating adoption of an evidence to recommendatio ns framework.
Information about the framework will be added here when available.
The ACIP also provides guidance for the development of health economics studies
(https://www.cdc.gov/vaccines/acip/committee/guidance/economic -studies.html ). These procedures should be
followed for economic analyses to be presented to the ACIP to ensure that economic data presented to the ACIP
and its W ork Group s are uniform in presentat ion, understandable, and of the highest quality.
Work Groups review  all of  the relevant published and unpublished data , including GRADE and economic
analyses  and implementation considerations .  Additionally, Work Groups  should seek additional data that  may
have been overlooked;  make  corrections in data content, evaluate appropriateness of the interpretation of data,
and critique and challenge expert opinions. Areas in need of additional research or data should be clearly
identified  in presentations to the full ACIP,  and each statement should include a specific delineation of data
gaps.
During ACIP’s decision making process the importance of the economic analyses and implementation
considerations must be balanced, while a lso ensuring that the recommendations remain focused on the
evidence base. Additionally, p ublic comments are solicited during the Committee meetings and are considered
during the decision making process.
Program staff compile and organize comments received  and discuss them with the appropriate Work Group
while redrafting recommendations.  The Chair of the Work Group is responsible for the final review of the draft
recommendations submitted for deliberation and approval by the full voting Committee.
Document s and data which will be discussed at the meeting must be disseminated to the Committee in a timely
manner for the members to have the time to review the information and prepare for productive discussions.  It is
the responsibility of the presenters/authors  to meet the timelines set by the ACIP Secretariat . These timelines
are generally set ten weeks in advance of the meeting.  Materials are sent electronically to the Committee
members  via email or the ACIP SharePoint site  fourteen days prior to the meeting d ates.

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 Meetings
Regularly scheduled meetings are held three times a year, at the call of the Executive Secretary.  Meeting dates
are announced 6 -12 months in advance.  Meeting dates and the location of the meetings are posted on ACIP ’s
home page shortly afte r the dates and location are selected.  At least 60 days prior to the meeting, the meeting
date, items to be discussed, and location are published in the Federal Register . Meetings traditionally are held in
Atlanta, Georgia.  All regular meetings are live webcast, with instructions for accessing the webcast available on
ACIP website before the meeting. Except as noted otherwise in these policies and procedures, the Chair will use
Roberts Rules of Order (Eleventh Edition) as a guide when conducting Comm ittee meetings.
In exceptional circumstances, the Director  of CDC may call an emergency meeting of ACIP without prior notice,
or with less than the usual 60-day notice in the Federal Register . If the notice cannot be published at least 60
days prior to the  meeting, the Federal Register  announcement will include the reasons for providing less than 60
days ’ notice, as provided under GSA regulations at 41 CFR § 102 -3.150(b).  If exigent circumstances make
publication of the Federal Register  notice prior to the meeting impossible, the notice shall be published in the
Federal Register  as soon as possible after the meeting.  In addition, under such circumstances, the agency shall
utilize other appropriate mechanisms for providing notice of the meeting prior to its o ccurrence.
ACIP meetings are generally open to the public for their entire duration.  However, there are or may be occasions
when the nature of the information is such that a closed meeting is required.  Examples might include
discussions of proprietary info rmation, information related to national security interests, or information related
to personnel action within CDC.  Participants in closed sessions may be required to sign pledges of nondisclosure.
All provisions of the Federal Advisory Committee Act and G overnment in the Sunshine Act regarding closed
sessions will be followed.
Selection of Topics
Potential topics for ACIP consideration can be suggested by anyone, but are most often proposed by CDC
program staff, FDA program staff, ACIP members, and vaccine  manufacturers.
Approximately ten weeks prior to an upcoming meeting, a memorandum requesting potential agenda items is
sent to ACIP voting members, CDC and FDA staff. The person suggesting an agenda item is asked to specify the
topic to be on the agenda,  issues of concern, and specific questions to be addressed by ACIP. Agenda items are
accepted for presentation by the Steering Committee.  The Executive Secretary has the authority to approve,
disapprove, or hold over to another meeting any agenda item subm itted for the agenda.
Voting
The Committee shall not take a vote unless a quorum of more than half of the voting members is present.
Whenever eight or more members are not eligible to vote, the Executive Secretary or  his or her  designee  shall
have the authority to temporarily designate the ex officio  members as voting members.  A majority vote is
accepted by the committee.  In the case of a tie vote, the Chair’s vote determines the final result.
Ex officio  members are expected to announce any conflicts of interest prior to any voting to determine if they
can vote.
ACIP is charged with providing advice and guidance regarding the use of vaccines and related agents (e.g.,
immune globulin preparations and/or antimicrobial therapy shown to be effective in controlling a disease for
which a vaccine is available) for the ci vilian population of the United States.   Upon the licensure of any vaccine

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 or any new indication for a vaccine, the committee shall, as appropriate, consider the use of the vaccine at its
next regularly scheduled meeting.   If the committee does not make a recommendation at the committee’s first
regularly scheduled meeting, the committee shall provide an update on the status of such committee’s review.
ACIP should  vote to make new recommendations when:
• There are no existing recommendations (previously not -vaccine preventable)
• The vaccine product uses a novel adjuvant
• The vaccine protects against different, or additional, serotypes, serogroups, etc.
• The age indication, number and/or schedule of doses, or population under consideration differs from
previous AC IP recommendations

ACIP does not need to vote on language for clinical guidance, but they can review CDC developed clinical
guidance.
The Committee shall not vote to recommend a vaccine prior to its licensure by the FDA, except where
extraordinary circu mstances exist that require potential use of a vaccine under an Investigational New Drug
application /Emergency Use Authorization . The Chair may ask members for their individual opinions on vaccine
recommendations prior to licensure in order to gain a sense  of the Committee’s thinking to provide program
staff and Work Group members with direction in developing draft recommendations.
All ACIP recommendations that are approved by the CDC Director are considered CDC policy once published in
the Morbidity and M ortality Weekly Report .
Internal Decision Memos
After ACIP recommendations have been submitted to the CDC Immediate Office of the Director (IOD), the CDC
Director may adopt or reject the recommendations.  The DFO prepares an internal decision memo addresse d to
the CDC Director and obtains the necessary CIO approvals.  Following these approvals, the DFO then submits this
decision memo to the CDC Director, on committee stationery, in a memo signed by ACIP Chair.  ACIP
Recommendations should not be posted by CDC , even as "provisional recommendations,” until the CDC Director
approves adoption of these recommendations. If the CDC Director adopts the recommendation(s), the decision
is documented on the internal decision memo.
If the CDC Director disagrees with one or more of ACIP recommendations, the decision is documented on the
internal decision memo.  The DFO works with CIO leadership to draft a memo for ACIP to address the Director’s
concerns. The Secretariat  will obtain any OD clearances of the draft memo as well as the CDC Director’s
approval.  If ACIP concurs with the CDC Director and issues modified recommendations, the Secretariat  proceed s
with CDC adopted recommendations (see above – Internal Decision Memo is approved ). If ACIP does not modify
its recommen dations, a second internal decision memo is created to brief the Director on the committee’s
recommendations.  If the Director still disagrees with ACIP recommendations, the Secretariat , with assistance
from the appropriate CIOs, drafts and publishes a F ederal Register Notice  with opportunity for 30 days public
comment  that articulates the Director’s views and proposed decision.

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 Publication of Recommendations
New and revised recommendations, once approved by the CDC Director, are published in the MMWR as a p olicy
note.  Comprehensive updates to ACIP recommendations, usually summarizing multiple ACIP recommendations
that have been published over a period, are published in the MMWR  as Recommendations and Report s.
Implementation and Evaluation of the Recommendati ons
Implementation and evaluation of the impact of the recommendations is the responsibility of the relevant CDC
program not ACIP.  However, CDC programs will periodically report information relevant to these activities to
ACIP and others who may be involve d in implementing the recommendation (e.g., managed care, private
practitioners).
Public Comment
ACIP holds open discussions and reserves meeting time for public comment , which is welcomed as an essential
aspect of the Committee’s deliberations . Public co mment is specifically invited on matters related to the ACIP’s
roles under the Vaccines for Children Program and the Affordable Care Act.  In addition, public comments can be
made on any topic relevant to the ACIP’s charge as listed in the committee’s Char ter.
Oral Public Comment Procedures
Each ACIP meeting will include at least 60 minutes of time for in -person oral public comment, as needed. The
oral public comment period will occur before any scheduled votes. Each speaker will be allotted 3 minutes to
present. Each speaker may only speak once per meeting unless invited by the ACIP Chair.
Priority will be given to individuals who submit a request to make an oral public comment before the meeting
and according to the procedures and deadlines in the Federal  Register Notice announcing the ACIP meeting and
on the ACIP meeting information website.
CDC will assign each individual  who submitted a request to make an oral public comment a unique identifier
number with no personally identifying information. After the deadline for submitting requests for oral public
comment has passed, the list of unique identifiers will be provided to  the Deputy ACIP Executive Secretary, who
will use a Microsoft Excel formula to randomize the list. The randomized list will then be used to determine the
order of speakers.
If more people request to make an oral public comment than can be reasonably accom modated during the
allotted public comment period at an ACIP meeting, CDC will determine the number of speakers that can be
reasonably accommodated in the designated oral public comment period and invite that number of speakers to
comment. CDC will use a l ottery system and allot time to speakers in the same order they appear in the
randomized list. CDC will not give preference to any individuals, organizations, or interests. For example, if CDC
determines that 20 speakers can be reasonably accommodated duri ng the oral public comment session, the first
20 individuals on the randomized list will be allotted time to speak, while the names after the first 20 will not be
allotted a time for oral public comment at that meeting. Any member of the public may still s ubmit a written
comment according to the procedures described below.
CDC will send email notification to individuals who have been allotted a time to provide an oral public comment
at an ACIP meeting. Individuals who have been allotted a time must visit t he CDC information desk at the
meeting and sign in. If an individual who has been allotted time to provide an oral public comment at an ACIP

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 meeting is unable to speak at the meeting, CDC may allow another person to provide the oral public comment
on the i ndividual’s behalf. CDC will provide the procedures for this substitution, if applicable, in the email
notification to individuals when they are allotted a time to provide an oral public comment.
On-site, in -person registration for oral public comment at the meeting will only be available if there is time
remaining in the oral public comment session after all individuals who submitted a request to make an oral
comment before the meeting have had an opportunity to speak. There is no guarantee there will be an
opportunity for on -site, in -person registration for oral public comment, and all individuals interested in making
an oral public comment are strongly encouraged to submit a request in advance of the meeting according to the
instructions in the Federal Register Notice and the ACIP meeting we bsite.
The ACIP Chair or DFO will announce at the beginning of the meeting if on -site, in -person registration will be
available based on the number of speakers allotted to speak during the oral public comment period. If on -site,
in-person registration is available, individuals must request an opportunity to speak according to the instructions
provided by the ACIP Chair or DFO at the beginning of the meeting. CDC will determine the order of speakers
according to the randomization process described above. If  more individuals request an opportunity to speak
than there is available time, CDC will conduct a lottery according to the process above.
In addition to the procedures above, the ACIP Chair has discretion to invite individuals to make an oral public
com ment outside of the designated comment period when relevant to the deliberations of the ACIP.
Written Public Comment Procedures
Any member of the public can submit a written public comment to ACIP. Written comments  will be accepted up
to 48 hours followi ng the end of an ACIP meeting. Comments must be submitted using the Federal eRulemaking
Portal: http://www.regulations.gov  using the docket number for the ACIP meeting provided in the Federal
Register Notice annou ncing the ACIP meeting and according to the instructions on regulations.gov. All relevant
comments received will be posted without change to http://regulations.gov , including any personal information
provided.  Comment s submitted by 72 hours before the meeting will be made available to ACIP members before
the meeting.

Rules of Conduct for ACIP Meetings

• An interested person who wishes to make an oral public comment during an ACIP meeting should  submit a
request with CDC before the meeting according to the instructions in the Federal Register Notice. Those who
have not submitted a request before the meeting will only have an opportunity to speak as time permits or
at the discretion of the Chair.
• Audience members may no t present comments or questions to the Committee unless recognized by the
Chair.
• Attendees may be subject to security screening, such as presenting identification, passing through metal
detectors, and inspection of briefcases, packages, and so on.
• Attendees at the meeting are asked to maintain order and not display behavior th at is disruptive to the
meeting.

11
 • The ACIP Chair or Designated Federal Officer will note on the record any disruptive behavior and will ask the
person to cease the behavior or e lse leave the meeting room.
• Attendees are asked not to approach the ACIP table area before, during, or after the m eeting without
permission from the  Designated Federal Officer/Executive Secretary.

Electronic Recording by Public Media
The Federal Advisory Committee Act states that advisory committee meetings be open to the public to the
extent allowed by law and physical environment.  The Chair and the Executive Secretary have the authority to
regulate all aspects of the meetings, including electron ic coverage.  To ensure the meeting is conducted in a fair
and expeditious manner, the Chair may restrict or deny use of electronic recording equipment.  Any member
finding lights or recording equipment disruptive to the conduct of business at the meeting sh ould inform the
Chair or Executive  Secretary.  Factors to guide the Chair in this determination include the potential for significant
disruption, prejudicial impact on the meeting, fairness, and impairment of a participant’s ability to make a
presentation o r participate freely in discussion.
ACIP Recommendations for the Vaccines for Children (VFC) Program
ACIP recommendations for the VFC Program are developed and voted upon in a separate process, distinct from
ACIP recommendations, after vaccines are license d. This process is based upon the unique statutory authority
for the VFC program established by the Omnibus Budget Reconciliation Act of 1993 (42 U.S.C. §1396s).  This
legislation gave ACIP the responsibility and authority to determine the vaccines, number of doses, schedule and
contraindications for the VFC Program.
Consistency between ACIP recommendations and VFC resolutions is a high priority.  Routine recommendations
and recommendations for individual clinical -decision making are included in VFC resolutio ns. In some situations,
usually for ease of implementation, the VFC resolution can be broader than ACIP recommendation.
For each vaccine considered for inclusion in the VFC program, written resolutions on the vaccine, schedule,
dose, contraindications, an d other issues relevant to appropriate uses of vaccines are reviewed by the
Committee and are adopted or rejected through votes by voting ACIP members.  A record of issues voted on is
maintained at CDC by ACIP Executive Secretary, and the requirements of ap proved VFC resolutions are
communicated to VFC providers through the state immunization programs.
Member Roles and Responsibilities
General Member Responsibilities
Attendance at Meetings
At public meetings of ACIP, the voting members vote on vaccine rec ommendations. Recommendations are
accepted by majority voting. Votes are recorded and the vote tally is captured in ACIP meeting minutes, which
are made available  to the public and posted on ACIP website. The committee is updated regularly following
implem entation of new vaccine recommendations on pertinent data such as post -licensure safety monitoring,
disease surveillance and outbreaks, and coverage.
ACIP meeting dates are published approximately six months to one year in advance. Except in the event of an
emergency, members of ACIP assume the responsibility of attending all meetings. At the discretion of the

12
 Executive Secretary, a member may be linked to a committee meeting by telephone or video conference, in
which case his or her  presence shall count t oward the quorum. When a member does not attend a meeting or
attends a portion of a meeting, the member is provided background material on the issues discussed, and is
expected to be prepared to fully participate in the next meeting. If a member finds it d ifficult to attend
meetings, he/she has the responsibility to resign from the Committee. This will allow for a new member to be
appointed to carry out the term. Failure by a member to actively participate in the work of the committee,
including through reg ular attendance at ACIP meetings, may result in a request by ACIP Executive Secretary to
the Secretary of Health and Human Services to declare the position vacant with replacement of the affected
member.
ACIP -Related Contacts
ACIP members may be solicited  to participate in consultations or surveys on vaccine issues that are addressed by
ACIP. ACIP members should not participate in such consultations or surveys if they are requested to participate
because of their ACIP membership status.
The Department’s St andards of Conduct prohibit "speaking" on matters related to an ACIP member’s official
duties outside Committee or Work Group meetings. ACIP members are prohibited from receiving compensation
for any speech or publication in which the purpose is to report on the member’s work on ACIP. Voting members
should be concerned with, and should report to the Executive Secretary, any solicitation of information about
the Committee’s activities by persons not officially affiliated with the Committee.
Media Interaction
As a federal agency, CDC's advisory committee meetings generally are open to the public and the media.
Therefore, Commit tee members may be approached by the media for an unscheduled interview.  Members are
not obligated to give an interview to the press either at the time they are approached or at a later time.
Members are free to give interviews and express their opinions, or the views of their employer, professional
organization, etc., but should  have CDC approval to speak as an ACIP member on ACIP matters.  CDC offers the
following  guidance to members who receive CDC authorization to conduct an interview:
• ACIP members may c hoose to do media interviews with other ACIP members or CDC staff present and
participating.
• Media inquiries or requests for interviews may be referred to the CDC Office of Health Communications’
representative.
• To avoid the appearance of bias, ACIP member s shall not speak to the media about what they believe to
be a likely outcome on an ACIP vote, prior to that vote being finalized.
• Members may discuss ACIP public meetings and their personal views, but must not disclose any
proprietary information.
• Members  are to be objective regarding issues brought before the Committee and should be aware that
any strong public statements on Committee matters prior to  a Committee vote could affect their future
participation in related meetings because of the appearance of  bias.
• Members should not speak to the press as representatives of either the Committee or the CDC, unless
the agency designates a member to speak for the Committee (e.g., the Chair).

13
 • Only the topic of discussion should be made public from closed portions of Committee meetings. Prior
to discussing any matter discussed in a closed session, the member should consult with the Executive
Secretary or a knowledgeable CDC staff member.
Committee Correspondence
Any correspondence (letter, fax, e -mail, etc.) should  be routed to the Committee Management Specialist for
ACIP who then consults with the Executive Secretary to determine who the most appropriate respondent is . In
some cases, the Chair of ACIP is the appropriate person; in other cases, it may be the Executi ve Secretary or
other CDC official or it may be the Chair of a Work Group.  However, no member should reply to official
correspondence without consulting the Executive Secretary.  The only exception to this rule is that all members
are free to respond to que stions about established points of fact (e.g., meeting dates, citations for ACIP
recommendations, etc.).
Responsibilities Specific to Member Roles
Chair
• Presides at all committee meetings and ensures that the agenda is adhered to as closely as possible. If it
is necessary for the Chair to leave the meeting due to a conflict of interest, the Chair shall appoint the
DFO, the Executive Secretary , or another committee member to preside. This i ncludes those meetings
conducted in person at the CDC as well as those special meetings that are called on an ad hoc  basis and
conducted via teleconference.
• Screens each voting ACIP member for conflicts of interest relevant to that vote  when a vote is to be
taken .
• Ensures that all rules of order and conduct are maintained during each session of an ACIP meeting.
When a committee member(s) is disqualified from participation in committee discussions, the Chair
ensures that the disqualified member does not participate and/or physically leaves the meeting room. In
addition , the Chair ensures that the minutes and transcript clearly indicate that the member did not
participate and/or was not present during the discussion.
• Calls on individuals for opinions and comments and terminates any discussion that is felt to be
unnecessary.
• Calls for a motion to be made and to be seconded when voting is required; calls for a vote when the
motion has been made and seconded.
• Calls for a nd controls public participation during the open portion of a meeting.
• Certifies to the accuracy of the minutes of each committee meeting prior to their distribution.
• With ACIP Secretariat, determines the need for establishment of new Work Groups and disb anding of
Work Groups when a Work Group has completed its tasks.
• Leads the administrative meetings that are conducted at each ACIP meeting, which include as
participants the voting ACIP members and selected CDC staff members. With ACIP Secretariat, develop s
the agenda for ACIP administrative meetings.
• With ACIP Steering Committee, assists in the development of the draft agenda for each ACIP meeting.
• As required, meets with ACIP Secretariat between ACIP meetings to discuss topics pertinent to ACIP (for
examp le, need for a new Work Group; emerging issues such as interruptions in vaccine supply,
development of influenza antiviral resistance, need to call an emergency ACIP meeting, new ACIP
initiatives, agenda for ACIP administrative meeting, etc.). Such meeting s generally are conducted via

14
 teleconference and are generally attended by ACIP Chair, Vice  Chair and ACIP Secretariat and others as
needed.
• Represents ACIP at key meetings of other Federal Advisory Committees. The Chair may designate an
alternate to atten d a meeting on his/her behalf, usually ACIP Vice  Chair; if the Vice  Chair is unavailable,
the Chair may request that another voting ACIP member attend on his/her behalf. Participation in such
meetings is generally funded by ACIP/ CDC.
Vice  Chair
• ACIP Chai r may call upon ACIP vice Chair to assist with any of the Chair’s roles and responsibilities, as
required.
• In particular, the Chair and the Vice  Chair may wish to divide responsibility for attendance at ACIP -
related meetings (such as other Federal Advisor y Committee meetings) that occur throughout the year.
Voting Members (including Chair and Vice  Chair)
The Chair and members of the Committee play a critical role in ensuring the Committee’s continued standing as
a nationally and internationally recognized leading body in the field of immunization . ACIP members are
expected to  observe the highest standards of impartiality, integrity and objectivity in their  deliberations , and
that their  recommendations should be  driven by available scientific evidence. Membe rs of ACIP will:
• Be committed to continued development and improvement in this important area of public health .
• Bring relevant experience to the Committee .
• Contribute to the provision of high quality and considered public health advice to the CDC and DHHS .
• Be expected to make a full and considered contribution to the work of the Committee and to contribute
fully to the debate and to the decision -making processes .
• Provide expert guidance when an issue that falls within their  particular area of expertise is u nder
discussion .
• Contribute to the debate in the capacity of a well -informed health professional when the issue does not
fall within their  expertise .
• Take into account  the need for and impact of vaccines, the quality and safety of vaccines and strategies
to ensure that the greatest benefit can be obtained from the most appropriate use of vaccines .
• Be prepared to respond quickly to interaction by e -mail .
• Be prepared, as requested by the Secretariat, to attend and contribute to the work of one or more of
ACIP work groups, which report to ACIP, and to attend occasional meetings of other Federal Advisory
Committees on vaccines for which representation of ACIP wo uld be needed .
• Be committed to declare all relevant interests. Any reported interest that could be perceived as a
potential conflict of interest will be disclosed during public ACIP meetings and in written meeting
minutes, which are posted on ACIP website.
All members serve in their personal capacity and should refrain from promoting the policies and views and
products of the organization/institution for which they work.
Conflicts of Interest when Participating as a Member
Upon appointment , each voting memb er is required to file an Office of Government Ethics 450 form (OGE450
http://www.oge.gov/Forms -Library/OGE -Form -450--Confidential -Financial -Disclosure -Report/ ) and a

15
 Confidential Financial Disclosure Report, which is reviewed by ACIP Secretariat, the Fed eral Advisory Committee
Management Branch and the Office of General Counsel at CDC. CDC will individually evaluate and consider for
waiver the related financial interests of each ACIP member in accordance with the OGE regulations at 5 CFR
Parts 2635 and 26 40, in particular to determine whether the need for the individual’s services outweighs the
potential for conflicts of interest created by the financial interests involved.  Taking into consideration the nature
of ACIP, the types of expertise necessary to a ccomplish its purpose, the various ways in which vaccine expertise
is developed, and the integrity of the advisory committee process, CDC will generally consider issuance of
waivers in specific situations as detailed in the Appendix.
Confidential Financial  Disclosure must be updated annually during a member’s term. At every ACIP meeting , the
Chair calls for conflict of interest disclosure from each voting member  at the opening of the meeting .
Additionally, each voting member must declare any conflict of in terest related to a particular vote  prior to the
vote  being  taken by ACIP. Any actual or perceived conflict of interests will be explored fully by the Secretariat,
CDC’s Federal Advisory Committee Management Branch, and CDC legal counsel if necessary. Memb ers with
declared interests will be asked to recuse themselves from participating in the discussion and decision  making of
the issues relating to that interest. A member who has any doubt as to whether he/she has an interest that
should be declared, or whe ther he/she should take part in the proceedings, should ask the Secretariat for
guidance.
As detailed below and  in the Appendix, ACIP members will have consented to the following requirements as a
condition of membership.
• No member, his or her  spouse, or a member of his or her  immediate family can be directly employed by
a vaccine manufacturer or its parent company.
• Members cannot hold stock in any vaccine manufacturer or its parent company in excess of the OGE de
minimus  amounts . Members also agree that t hey, their spouse and minor children will not purchase
such stock during their tenure on the committee.
• Members cannot be holders of or otherwise be entitled to royalties or other compensation for a patent
on a vaccine product or process, immunologic agen t, adjunct or preservative that can be used for a
vaccine that may come before ACIP during the anticipated term of appointment under consideration.
• Members agree to resign any advisory or consulting roles, whether paid or unpaid, to a vaccine
manufacturer  (except participation in clinical trials or service on data monitoring boards) and to forego
such consultation or membership on any vaccine manufacturer advisory committees (except
participation in clinical trials or service on data monitoring boards), du ring his/her tenure on ACIP.
• Members forego solicitation or acceptance of funds from vaccine manufacturers on behalf of
themselves or others.
• During their tenure on ACIP, members do not serve as a paid litigation consultant or expert witness in
litigation involving a vaccine manufacturer.
• Members do not accept honoraria or travel reimbursement with a funding source from a vaccine
manufacturer for attendance at scientific meetings, with the exception that they may receive travel
reimbursement for CME present ations where the source of funding is an unrestricted grant to the CME
provider by a vaccine manufacturer.

16
 Membership Policies and Procedures
Voting Members
Appointment of ACIP members is made by the Secretary of Health and Human Services upon the proposal of the
Steering Committee, but the Secretary may select members other than those recommended by the Steering
Committee. Members of ACIP are appointed to serve for a term of four years, which in general is not renewable.
Appointments and Tenure
Members will be appointed for a term of four years, which typically begins on July 1 in the year of appointment.
In general, a member’s term may not be extended beyond four years, and appointment to a second term is not
allowed. In cases when a new round of appointees has not been approved by the Secretary to begin their terms,
existing ACIP members may be asked to extend their terms until their replacements have been appointed.
The Chair shall be appointed for a term of three years. The Chair is selected and  appointed by the Secretary, HHS
from among voting ACIP members who have had at least two years of experience serving on ACIP and have
demonstrated the ability both to lead the work of similar bodies and to work effectively with CDC.
New Members
Membership Qualifications
ACIP members are acknowledged experts with an outstanding record of achievement in their own field s and an
understanding of the immunization issues covered by ACIP. They have a responsibility to provide CDC with high
quality, well -considered advice and recommendations on matters described in ACIP Charter.
Solicitation for Nominees
Each year, suggestions for members are sought from a variety of sources , including professional societies,
current and former ACIP members, vaccine manu facturers, and the general public.  During the year , suggestions
for membership to the Committee are received from various sources.  These submissions are compiled for
consideration along with those received from the solicitation.  When openings for membershi p occur, a
solicitation for nomin ations  will be posted on ACIP home page and published in the Federal Register .
Selection of Nominees
A listing of individuals suggested for nomination to the Committee is prepared and forwarded to the Executive
Secretary, A CIP, and Steering Committee members.  These individuals discuss the qualifications of the candidates
and the expertise needed on the Committee to develop a slate of potential nominees.  Selected c andidates are
then contacted to determine their willingness to  serve on the Committee and to adhere to limitations in their
financial relationships with vaccine manufacturers as described in this document.
All appointed ACIP members become Special Government Employees, subject to the federal laws that prohibit
partic ipation in matters in which they have a financial interest.  Candidates must agree to comply with ACIP
policies and procedures.  With concurrence from the candidate s, the slate of nominees is submitted to the
Director  of CDC for concurrence and authorization  to prepare the nomination package.
The Director  of CDC approves the final nomination package , which is  then  submitted to the HHS Secretary . The
Secretary is responsible for appoint ing the member(s) to the Committee , who may or may not be those
nominated by CDC.  If an appointment is confirmed by the Secretary, the new member serves for a term of up to
four years.  A member who is unable to fulfill the full term on the Committee may resign by submitting a letter of

17
 resignation to the Executive Secretary.  If a member resigns, a new member is appointed to fill the remainder of
the unexpired term.
Once the name of an individual is submitted as a possible nominee to the Committee, the name and information
received on the ca ndidate is held and may reconsidered in a future year if that person expresses an interest in
continuing to be considered .
Notification to Applicants
Once the nomination package is submitted , both applicants who have and have not been put forward are
notif ied. After  approv al, the Secretary of HHS sends letters of congratulation to those candidates accepted for
service on ACIP. The respondents return an attached form to indicate acceptance (or non -acceptance) of
appointment.
Once selection is finalized, cand idates who were not selected will be sent an official letter .  Candidates not
selected may be reconsidered  for the following year.
Consideration for Nomination : Financial Conflicts of Interest
In order to achieve the highest quality comprehensive recommen dations for administration of vaccines, it is
critical that individuals chosen for membership on  ACIP have significant vaccine and immunization expertise,
including crosscutting  knowledge and experience in the various  aspects  of the immunization field.  Som e
expertise important to the committee can only be developed through working relationships with vaccine
manufacturers, which are in a position to be financially affected by many of the recommendations of ACIP.
Federal law (18 U.S.C. §208) prohibits federal  executive branch employees, including Special Government
Emplo yees (e.g., members of Federal A dvisory Committees such as ACIP), from participating in matters in which,
to their knowledge, they, their spouse, minor child, or organization has a financial interest.  CDC is sensitive to
concerns about potential conflicts of interest by members serving on ACIP, particularly given the substantial
financial implications some ACIP recommendations may have for vaccine manufacturers.  Therefore, to assure
the integrity of the committee, CDC has taken steps to assure that there is not only technical compliance with
the ethics statutes and regulations regarding financial conflicts and the appearance of financial conflicts of
interest, but also that more gener al concerns regarding the potential for the appearance of a conflict are
addressed, or avoided altogether, through both pre - and post -appointment considerations.  CDC has concluded
that particular interests create conflicts, or perceptions of conflicts, whi ch either contribute little or nothing to
the ongoing level of expertise required on the committee, or create an appearance of such a strong interest in
the success or failure of the products of a vaccine manufacturer, that such interests should disqualify  an
individual from membership on the committee.  These include:
• A person will be not be considered for membership if they, their spouse, or a member of their
immediate family is directly employed by a vaccine manufacturer or its parent company.
• Persons who  hold stock in any vaccine manufacturer or its parent company in excess of the Office of
Government Ethics ( OGE ) de minimus  amounts will not be considered for nomination unless they agree
to divest themselves of such stock before their term of office begin s and all nominees must agree that
they, their spouse and minor children will not purchase such stock during their tenure on the
committee.

18
 • A person will be not be considered for membership if that person is a holder of, or otherwise is entitled
to royalt ies or other compensation for, a patent on a vaccine product or process, immunologic agent,
adjunct or preservative that can be used for a vaccine that may come before ACIP during the anticipated
term of appointment under consideration.
• To be considered f or appointment to ACIP, a potential nominee must agree to resign any advisory or
consulting roles, whether paid or unpaid, to a vaccine manufacturer (except participation in clinical trials
or service on data monitoring boards) and to forego such consultat ion or membership on any vaccine
manufacturer advisory committees (except participation in clinical trials or service on data monitoring
boards), during his/her tenure on ACIP.
• Except as allowed under the previous bullet , potential nominees must agree that  during their tenure on
ACIP they will forego solicitation or acceptance of funds from vaccine manufacturers on behalf of
themselves or others (e.g., to support educational activities of their Department or an organization of
which they are a member, offic er or employee).
• Potential nominees must agree that during their tenure on ACIP they will not serve as a paid litigation
consultant or expert witness in litigation involving a vaccine manufacturer.
• Potential nominees must agree that during their tenure on ACIP they will not accept honoraria or travel
reimbursement with a funding source from a vaccine manufacturer for attendance at scientific
meetings, with the exception that they may receive travel reimbursement for CME presentations where
the source of fun ding is an unrestricted grant to the CME provider by a vaccine manufacturer.

Orientation and Education
Orientation for new members is provided to enable members to fully understand the work and functioning of
ACIP, including participation in ACIP work groups. This is typically offered as a two-hour  teleconference/webinar
within one month of appointment of n ew members. The Secretariat will further arrange briefing and meetings
with CDC staff and any other training in order to facilitate the full engagement of new members in the work of
ACIP. From time to time, ACIP Secretariat arranges educational sessions on  topics such as the role of health
economics in development of ACIP recommendations, immunization safety monitoring and procedures used in
development of evidence -based recommendations. These sessions are sometimes held at the CDC on the day
before an ACIP  meeting.

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Table. ACIP Membership (as of June 2022 )
Group  n Description of members
Voting members  ≤19 Subject matter experts in vaccinology, immunology, pediatrics, internal medicine,
nursing, family medicine, virology, public health, infectious diseases, and/or
preventive medicine
1 Consumer representative who provides perspectives on the social and community
aspects of vaccination.
Ex officio  members
(non -voting)  6 Individuals in the roles listed below or their designees.
• Director, Division of Vaccine Injury Compensation, Bureau of Health Professions,
Health Resources and Services Administration
• Director, Center for Biologics Evaluation and Research, Food and Drug
Administration
• Director, Center for Medicaid and State Operations, Centers for Medicare and
Medicaid Services
• Director, Division of Microbiology and Infectious Diseases, National Institute of
Allergy and Infectious Diseases, National Institutes of Health
• Director, Indian  Health Service
• Director, National Vaccine Program Office, HHS
Liaison representatives
from professional
organizations (non -
voting)  31 Participating organizations:
• American Academy of Family Physicians
• American Academy of Pediatrics
• American Academy of Ph ysician Assistants
• American College Health Association
• American College of Nurse Midwives
• American College of Obstetricians and Gynecologists
• American College of Physicians
• American Geriatrics Society;
• America’s Health Insurance Plans
• American Medical Association
• American Nurses Association
• American Osteopathic Association
• American Pharmacists Association
• Association of Immunization Managers
• Association for Prevention Teaching and Research
• Association of State and Territorial Health Officials
• Biotechnology Industry Organization
• Council of State and Territorial Epidemiologists
• Canadian National Advisory Committee on Immunization
• Infectious Diseases Society of America
• National Association of County and City Health Official
• National Association for Pediatric Nurse Practitioners
• National Foundation for Infectious Diseases
• National Immunization Council and Child Health Program, Mexico
• National Medical Association
• National Vaccine Advisory Committee
• Pediatric Infectious Diseases Society

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   • Pharmaceutical R esearch Manufacturers of America
• Society for Adolescent Health and Medicine
• Society for Healthcare Epidemiology of America

21
 Appendix . Member Conflicts of Interest and Financial Interests
ACIP members must file Office of Government Ethics (OGE) Confidential Financial Disclosure Reports, Form 450,
as required by OGE regulations and the CDC policy and the Financial Disclosure for Federal Advisory Committee
Members Appointed as Special Governm ent Employees.  CDC will individually evaluate and consider for waiver
the related financial interests of each ACIP member in accordance with the OGE regulations at 5 CFR Parts 2635
and 2640, in particular to determine whether the need for the individual’s services outweighs the potential for
conflicts of interest created by the financial interests involved.  Taking into consideration the nature of  ACIP, the
types of expertise necessary to accomplish its purpose, the various ways in which vaccine expertise is
developed, and the integrity of the advisory committee process, CDC will generally consider issuance of waivers
as follows:
1. Limited Waivers.  Where conflicts exist, only limited 208(b)(3) waivers will be considered, except as noted in
number 6, below.
2. Scope of Limited Waivers.  Limited waivers will generally allow members to fully participate in committee
discussions related to waived interests, with the condition that they will be prohibited from voting on such
matters (except in the case of de minimus  interests which do not disqualify a member from voting).  In addition,
members will be prohibited from serving as chairs of subcommittees or Work Groups considering issues where
conflicts exist.
3. Clinical Trials.  A member who is serving as a pri nciple investigator or as a member of a data monitoring board
on manufacturer -sponsored research will be considered for issuance of a limited 208(b)(3) waiver to serve as a
consultant to present to ACIP on matters related to this manufacturers’ vaccine, bu t cannot participate in
deliberations or vote on such issues.  The member may be granted a waiver as described in number 2, above, for
issues related to other vaccines produced or marketed by that manufacturer.
4. Public Disclosure.  In order to assure that their fellow committee members and the public are aware of a
member’s related financial interests;  continued membership on the committee will be conditioned on the
member’s agreement to publicly disclose all vaccine -related interests and work, including pa rticipation in clinical
trials, at the beginning of each ACIP meeting.
5. Vaccine Stocks.  As provided in section B.1.b., except as allowed under OGE regulatory exemptions for de
minimus  amounts, members must agree to not own vaccine stocks during their com mittee tenure.  In order to
avoid even the appearance of a conflict, ownership of any amount of vaccine stocks is discouraged.  Therefore,
ownership by the member, spouse or minor children of de minimus  amounts of stock in any vaccine
manufacturer or its par ent company must be disclosed at the beginning of each ACIP meeting.
6. Disclosure Not Required - Uncontrolled Interests.  The member's employing institution may have financial
interests which provide income to the member (e.g., grant funds deposited into a  common account), but which
interests are outside the member's area of work.  Such interests are considered outside the member's control, as
are an employing institution’s financial interests that  do not provide income to the member.  Given the lack of
contr ol, those interests, if they may be imputed to the member under 208, will generally be waived under
208(b)(3) and, if waived, are not required to be disclosed.  There are no restrictions on Committee activities
based on such waived interests.

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 7. Tenure Comm itments.  Continuing membership on the committee and issuance and maintenance of any
waiver will also be conditioned on the member’s fulfillment of commitments noted in section B.1 regarding
interests during their tenure on the committee.

Summary: Advisory Committee on Immunization  Practices Policies and Procedures     June 2022     i     Contents   Introduction  ................................ ................................ ................................ ................................ ..................  1  Organization of this Document  ................................ ................................ ................................ .................  1  ACIP Structure  ................................…