Core Vaccination Strategy Changing in the US.

Great Barrington Declaration vs. John Snow Memorandum

The Advisory Committee on Immunization Practices (ACIP) is the U.S. Centers for Disease Control and Prevention (CDC) body made up of public health, immunization, epidemiology, clinical experts, etc. It recommends how vaccines should be used in the civilian U.S. population (who gets which vaccine, when, who is eligible, etc.). Recommendations from ACIP become official once adopted by the CDC Director and are published via the Morbidity and Mortality Weekly Report.

In June 2025, Health and Human Services Secretary Robert F. Kennedy Jr. dismissed all 17 members of ACIP. He cited concerns about conflicts of interest and described the existing committee as a “rubber stamp” for vaccines. Eight new members were appointed, including some who have previously expressed skepticism about mRNA vaccines, childhood vaccinations, or policies mandating vaccines. In a parallel change, certain external medical organizations (AMA, AAP, etc.) were removed from ACIP’s workgroups, citing concerns about bias.

On September 18 and 19, the revamped ACIP will meet to discuss and vote on recommendations for the following vaccinations:

·       Measles, Mumps, Rubella, and Varicella (MMRV) Vaccines

·       Hepatitis B vaccine

·       COVID-19 vaccine

Two Sides take shape during COVID-19 Pandemic.

In 2020, two competing visions for handling COVID-19 took center stage: the Great Barrington Declaration (GBD) and the John Snow Memorandum (JSM). Their clash over how to balance freedom, safety, and science quickly became a flashpoint in the U.S. vaccination debate.

The Great Barrington Declaration (GBD) was drafted in October 2020 in Great Barrington, Massachusetts, by Dr. Martin Kulldorff of Harvard, Dr. Sunetra Gupta of Oxford, and Dr. Jay Bhattacharya of Stanford. It gained momentum with backing from some libertarian and free-market think tanks. In response, the John Snow Memorandum (JSM) was published shortly afterward in The Lancet in October 2020. Named after John Snow, the 19th-century physician who famously halted a cholera outbreak, the memorandum was signed by more than 6,900 scientists, researchers, and health professionals from around the world.

The GBD promoted a strategy called “Focused Protection.” It argued that the virus should be allowed to spread largely unchecked among healthy, low-risk populations, while society concentrated on safeguarding the most vulnerable, such as the elderly and immunocompromised. The ultimate goal was to achieve natural herd immunity more quickly, minimizing the economic and social harms of lockdowns. By contrast, the JSM called for “Comprehensive Suppression and Control”. It dismissed herd immunity through infection as both unethical and scientifically unsound, instead endorsing the use of non-pharmaceutical interventions like masking, distancing, and limits on gatherings. The memorandum emphasized strong government action until vaccines and effective treatments could be rolled out.

The GBD rested on several key assumptions: that younger and healthier people faced minimal risk of severe illness or death, that vulnerable populations could be effectively shielded while others resumed normal activities, and that natural infection would confer durable immunity that eventually protected society as a whole. The JSM, however, assumed that fully protecting vulnerable groups was impossible due to intergenerational households and the reliance of many elderly individuals on caregivers. It warned that uncontrolled spread could overwhelm healthcare systems and highlighted uncertainty around the durability of infection-induced immunity. Instead, it maintained that vaccines represented the only safe and sustainable path to herd immunity.

Supporters of the GBD framed lockdowns as harmful to mental health, education, livelihoods, and civil liberties, placing strong emphasis on individual freedom and minimizing collateral damage from restrictions. The JSM, on the other hand, framed herd immunity via infection as socially inequitable and a violation of public health ethics. It stressed collective responsibility and the moral imperative of preventing unnecessary deaths, even at the cost of temporary restrictions.

Had the GBD been widely adopted, it would have meant reopening businesses, schools, and public spaces much sooner for low-risk groups, while limiting restrictions to targeted protections for vulnerable populations. However, such an approach carried the risk of large infection waves and uncertain long-term consequences, such as the rise of Long COVID. The JSM’s recommendations, if followed, required continued population-wide restrictions until vaccines became available. This strategy imposed significant short-term economic, social, and psychological costs but promised a lower immediate death toll compared to uncontrolled spread.

The GBD attracted attention among political leaders who favored minimal restrictions, but it was heavily criticized by mainstream scientific and public health organizations, including the WHO, CDC, and NIH. Many experts argued that it underestimated the risks of COVID-19 and that its plan to shield vulnerable groups was impractical. In contrast, the JSM was widely endorsed by leading public health bodies and major journals. Nonetheless, it drew criticism from libertarian and anti-lockdown advocates, who argued that its approach was overly restrictive and damaging to freedoms and economies.

Looking back, many of the GBD’s predictions fell short. It underestimated the difficulty of protecting the vulnerable, overlooked the prevalence of Long COVID among younger populations, and assumed that infection-induced immunity would be long-lasting—an assumption later undermined by evidence of waning immunity and new variants. The JSM, by contrast, more accurately anticipated ongoing waves of infection and the strain on health systems without strong mitigation measures. Its emphasis on suppression proved more consistent with the eventual reliance on vaccines. Still, critics argue that the JSM underestimated the harms of prolonged restrictions, including mental health decline, learning loss, and growing economic inequality.

In summary, the Great Barrington Declaration prioritized freedom, economic continuity, and selective protection, but depended on questionable assumptions about immunity and shielding. The John Snow Memorandum prioritized comprehensive suppression to save lives until vaccines became available, but required prolonged restrictions that came with significant social and economic costs.

How the new ACIP seems to shift and how that aligns with these philosophies.

Preliminary observations suggest that the newly restructured ACIP may demonstrate greater receptivity to perspectives that emphasize vaccine safety scrutiny and individual choice, reflecting positions more closely aligned with elements of the Great Barrington–adjacent philosophy than with traditional public health mandates.

Several developments point to this possibility. The inclusion of members who have previously expressed concerns about mRNA vaccines or vaccine mandates could influence how recommendations are articulated, potentially placing greater weight on risk–benefit assessments, side effect profiles, and voluntary uptake. The removal of external medical society workgroups may also lessen the influence of established public health institutions that have historically supported broad vaccine coverage. Furthermore, the stated rationale for the changes, including goals such as “restoring public trust” and reducing conflicts of interest, indicates a cautious approach to broad or mandate-oriented vaccine policies.

Collectively, these changes suggest a structural shift toward a more conservative framing of vaccine policy, in contrast to prior ACIP compositions that operated closer to the John Snow perspective of population-level mitigation, broad vaccine uptake, and strong public health measures.

What this might mean in practice.

Given these changes, here are possible outcomes for how ACIP's recommendations might change or be influenced:

• Vaccine schedules and mandates: There may be pushback against vaccine mandates (e.g. for schools or workplaces). ACIP might put more emphasis on “voluntary uptake” and perhaps issue more “permissive” recommendations rather than strict requirements.

• Risk/benefit transparency: Greater debate about vaccine side effects, stratified risk (age, health status). Might see more nuanced recommendations for lower-risk populations (e.g. adults under certain ages) or different booster strategies.

• Prioritization: Possibly greater attention to whether vaccine resources should first target vulnerable groups (older adults, immunocompromised) rather than universal recommendations, especially under budget/availability constraints.

• Communication framing: More caution about broad mandates in messaging; possibly more stress on individual decision making, more attention to dissenting voices or safety concerns.

• Scope of vaccine recommendations: Maybe slower approval or recommendation of new vaccines or new uses (e.g. boosters, pediatric vaccines), as safety concerns might be given more weight, or demand stronger data.

Emerging Orientation with New ACIP

Preliminary observations suggest that the newly restructured ACIP may demonstrate greater receptivity to perspectives that emphasize vaccine safety scrutiny and individual choice, reflecting positions more closely aligned with elements of the Great Barrington–adjacent philosophy than with traditional public health mandates. Several developments point to this possibility. The inclusion of members who have previously expressed concerns about mRNA vaccines or vaccine mandates could influence how recommendations are articulated, potentially placing greater weight on risk–benefit assessments, side effect profiles, and voluntary uptake. The removal of external medical society workgroups may also lessen the influence of established public health institutions that have historically supported broad vaccine coverage. Furthermore, the stated rationale for the changes, including goals such as “restoring public trust” and reducing conflicts of interest, indicates a cautious approach to broad or mandate-oriented vaccine policies.

Collectively, these changes suggest a structural shift toward a more conservative framing of vaccine policy, in contrast to prior ACIP compositions that operated closer to the John Snow perspective of population-level mitigation, broad vaccine uptake, and strong public health measures.

Limits and Uncertainties.

That said, it remains premature to conclude that the new ACIP will fully embrace a Great Barrington–style orientation. Vaccine policy is only one dimension of its work, and the urgency of disease prevention, prevailing public health consensus, and accumulating data on vaccine safety and efficacy continue to play a central role in decision-making. Public information about the views of individual members is limited; while some appointees are known for skepticism or criticism of prior policies, the extent and nuance of their influence remain uncertain. Moreover, external factors—including emerging scientific evidence, epidemiologic data on cases, hospitalizations, and mortality, and the role of media discourse—will continue to weigh heavily in shaping recommendations. Finally, the panel operates within broader legal and political constraints, such as school vaccine requirements and insurance coverage policies, which limit the degree to which ACIP can, or is willing to, depart from established public health practices.

Implications Going Forward.

Taken together, these observations point to a potentially significant, though not absolute, shift in how ACIP may approach vaccine policy. The new structure appears more open to concerns about individual choice, transparency, and safety scrutiny, yet its recommendations will continue to be shaped by scientific evidence, legal frameworks, and broader public health priorities. The result may be a recalibration rather than a wholesale reorientation—balancing skepticism toward mandates with the continued need for population-level protection. How this balance plays out will depend not only on the internal dynamics of the panel but also on evolving data, political pressures, and the enduring tension between individual autonomy and collective responsibility in public health.