By failing to adopt blanket age-based COVID-19 vaccine recommendations, the Advisory Committee on Immunization Practices (ACIP) has created uncertainty among physicians and adults, including seniors.

Rather than following previous ACIP guidance, the committee issued a watered-down recommendation for the 2025-26 vaccine season. They replaced the broad age-based advice the committee previously issued with a new recommendation: that all people six months and older consult with their physicians or other clinicians before deciding to get the COVID-19 vaccine. Additionally, the committee removed the comprehensive guidance stating that all adults 65 and older receive the vaccine.

It’s important to note that all of these changes came after Health and Human Services Secretary Robert F. Kennedy Jr. fired the previous members of ACIP, replacing them with his own handpicked members, including five who were added just four days before the meeting. 

“Some of those he chose have a history of being critical of vaccines, as does Kennedy himself,” NPR reported, adding that Kennedy once called COVID-19 vaccines a “crime against humanity.” The newly constituted committee was meeting for the first time to issue federal guidance on the safety of vaccines to all Americans. 

Why this matters

ACIP’s new recommendation leaves many patients and providers unclear about current advice and whether they can obtain a vaccine in certain states. Journalists can check out this map of states showing vaccine availability and states that have issued their own guidance. Reporters can also ask local and state health officials how to facilitate access, reduce barriers to vaccines, and ensure that those in nursing homes and others at high risk are protected. 

“It’s hard to parse what this actually means in practice,” commented William Schaffner, M.D., professor of infectious diseases at Vanderbilt University Medical Center. “I hope the pharmacy chains recognize this and don’t require documentation from health care providers.”

Failing to make comprehensive recommendations for all adults over 65 and those with serious medical conditions was a significant shift from previous CDC guidance, vaccine experts said. Schaffner advised journalists to ask pharmacy chains and local and state medical associations what they are doing to ensure that adults and children can get vaccinated. “It would help if the major pharmacy chains would issue a statement to the effect that if you present yourself for vaccination, we will give you the vaccine,” he said.

Awaiting CDC approval

The committee’s proposal “…includes an emphasis that the risk-benefit of vaccination in individuals under age 65 is most favorable for those who are at an increased risk for severe COVID-19 and lowest for individuals who are not at an increased risk.” People should consult with their physicians when deciding to get the COVID-19 vaccine, the committee added.

The ACIP’s recommendations will not become final without the approval of CDC acting director Jim O’Neill, who was named acting CDC director on Aug. 28, as Dan Diamond reported for The Washington Post. In June, the U.S. Senate confirmed O’Neill as deputy HHS secretary. Previously, O’Neill served in the George W. Bush administration as a senior health official. 

If O’Neill confirms ACIP’s recommendation, the guidance will shape how health care providers and patients approach COVID-19 vaccination decisions in the coming year. That guidance was released on Sept. 19, at the end of a contentious two-day meeting, as Will Stone, Rob Stein, Pien Huang and Selena Simmons-Duffin reported for NPR. 

“Individual decision-making is referred to on the CDC’s adult and child immunization schedules as vaccination based on shared clinical decision-making, which references providers including physicians, nurses, and pharmacists,” the committee said in an announcement after the meeting. “It allows for immunization coverage through all payment mechanisms, including entitlement programs such as the Vaccines for Children Program, Children’s Health Insurance Program, Medicaid, and Medicare, as well as insurance plans through the federal Health Insurance Marketplace.”

A confusing patchwork

In response to the committee’s decision, the Common Health Coalition called ACIP’s vote against a universal COVID-19 vaccine controversial. Also, the coalition added, the decision could cause pharmacies to fail to recognize the CDC’s revised guidance, leading to an already confusing patchwork of requirements and vaccine availability nationwide. To better serve patients and communities, the coalition is bringing together health insurers, providers, health systems and public health leaders to prepare for the coming respiratory virus season. 

Some states released their own requirements for eligibility, as Shalina Chatlani noted for Stateline on Sept. 17. But in other states, such rules were unavailable or limited, as Graig Graziosi reported for The Independent on Aug. 30. Those differences could change now that the committee has issued its recommendations and some medical groups have issued their own recommendations. And, health associations and immunology experts have called on the administration to follow the science. Following the science could mean urging older adults and others at high risk to get the latest booster.

Another important point about COVID-19 is that while the virus was extant during the peak of the pandemic, “It hasn’t disappeared,” Schaffner cautioned. For that reason, health departments and medical societies should advise the public about the continuing risks, he said. 

The value of booster shots

For older adults, ACIP created confusion among seniors by failing to address their need for booster shots, said Pamela G. Rockwell, D.O., clinical professor of family medicine at the University of Michigan Medical School. The chair of the Michigan Advisory Committee on Immunizations, Rockwell, is also a former ACIP liaison for the American Academy of Family Medicine. 

One positive note, Rockwell said, was that the panel voted against a motion that states and other jurisdictions require a prescription for COVID-19 vaccines. Only states and localities can make that decision, not the CDC, as Joseph Choi reported for The Hill. 

“I want to believe that our pharmacists who are dispensing vaccines and all the physicians who are recommending it are not following anything but the evidence,” Rockwell added. While COVID-19 cases have been rising in Michigan, state officials have recommended vaccines for everyone six months and older and especially for those at higher risk.

“There is no working CDC in my mind right now,” Rockwell said in a phone interview. “There has been no science presented to change any of the recommendations that stood prior to the CDC being held hostage and taken over.”

For older adults and those with underlying health conditions that increase their risk of severe COVID-19 — including heart disease, diabetes, and compromised immune systems — the vaccines remain a critical tool for protection, Rockwell said. ACIP’s new guidance puts the burden on health care providers to identify these high-risk patients and engage in conversations about the benefits and risks of vaccination.

Insurance coverage, for now

Through the end of next year, health insurers are expected to continue to cover COVID-19 and other recommended vaccines for older adults, according to a statement from America’s Health Insurance Plans, which represents the nation’s largest health insurers.

“Health plans will continue to cover all ACIP-recommended immunizations that were recommended as of Sept. 1, 2025, including updated formulations of the COVID-19 and influenza vaccines, with no cost-sharing for patients through the end of 2026.” AHIP added, “…the evidence-based approach to coverage of immunizations will remain consistent.”

For Medicare members with Part D prescription drug plans and for Medicaid members, vaccines have been free since 2023, according to the National Council on Aging. There are no co-payments or deductibles for any vaccinations that ACIP recommends.

Schaffner cautioned, however, that ACIP members understand that the federal Centers for Medicare and Medicaid Services could stop covering vaccines. “The ACIP is indeed cognizant of the funding part of the equation,” he said. “If they wish to put up barriers to vaccination, they’ll work on other aspects of funding down the line.”  

Health insurers that are members of the Alliance of Community Health Plans have no plans to change their coverage of vaccines, Jennifer Lee, M.D., ACHP’s chief medical officer, said in an emailed statement. The 30 health insurers operate in 40 states and the District of Columbia. ACHP members understand the importance of vaccines and use scientific sources to determine coverage, including ACIP and evidence from professional medical organizations, she added. “And they know the clinical value of providing vaccines with no cost to consumers,” Lee noted.

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