The Centers for Disease Control and Prevention vaccine safety committee voted unanimously Friday afternoon to no longer positively recommend COVID-19 vaccines for adults, instead advising “shared clinical decision-making” between patients and their healthcare providers.
If the acting CDC director signs off on the recommendation, the Advisory Committee on Immunization Practices’ vote on COVID-19 vaccines means that adults and children are no longer recommended to get the vaccine, but will still be able to do so if they desire.
In the same meeting, though, the committee also voted to require insurance coverage for the vaccine, which could ease concerns that the new guidance could make it harder for people to access the shots.
Last month, Health and Human Services Secretary Robert F. Kennedy Jr. announced that the COVID-19 vaccine would only be recommended for the elderly or those with comorbidities for severe disease, which led critics to warn that the shots would be hard to get for people in states where pharmacies tie vaccine availability to ACIP recommendations or for people whose insurers would drop coverage.
The panel plays a crucial role in determining vaccine access, as most private insurance companies peg their coverage decisions to ACIP recommendations. Public health insurance programs, including Medicaid, Medicare, and Obamacare marketplace plans, are required to cover all products recommended for use by the ACIP.
ACIP Chairman Dr. Martin Kulldorf told the committee that its recommendation to switch to a “shared clinical decision-making” model, also known as individual-based decision-making, in practice will mean that “there is no insurance restrictions on getting this vaccine.”
Kulldorf said that the new rule would “allow coverage with $0 cost-sharing” under the Children’s Health Insurance Program, Medicare, Medicaid, and Obamacare exchange plans.
Although panel members still agreed that those with comorbidities for severe disease, such as obesity and heart disease, would be best served by getting the vaccine, its recommendation allows for so-called “individual-based decision-making” between patient and healthcare provider to determine an individual risk-benefit profile.
The September ACIP meeting was conducted under the specter of the firing of CDC Director Susan Monarez by Kennedy and President Donald Trump in late August.
Monarez told the Senate during an oversight hearing about her termination that she was fired because she refused to “preapprove” decisions to alter the childhood vaccine schedule during this week’s ACIP meeting, regardless of the scientific evidence.
The committee also voted during the September meeting to no longer recommend the combined measles, mumps, rubella, and chicken pox vaccine for infants under 4, instead recommending two separate vaccines. ACIP also voted to table a recommendation to no longer recommend a universal birth dose against Hepatitis B.
ACIP member Retsef Levi, an operations research specialist from Massachusetts Institute of Technology, led the committee’s working group on COVID-19 vaccines and presided over a wide-ranging scientific discussion on its associated risks.
Although securing insurance coverage will ensure access to the vaccines, the committee also considered a motion, championed by Levi, to require a prescription for COVID-19 vaccines.
The committee was divided with a vote of 6-6, but Kulldorf, voting ‘No,’ broke the tie.
Neither ACIP nor CDC can control whether or not states require prescriptions, and Levi said that over 40 states currently allow pharmacists in some capacity to prescribe vaccines or other pharmaceutical products directly to patients.
“I don’t think it’s going to lead to any access problem, because most states have a solution; the states that don’t have a solution can either find a solution based on pharmacies or reject that,” said Levi.
Epidemiologist Dr. Catherine Stein, who was appointed to ACIP by Kennedy on Monday, said she was “really concerned about the requirement of a prescription.”
“The segment of the population that is underinsured has lack of access to healthcare, they’re going to be unable to get a prescription, and those are the people that are at highest risk for a lot of these comorbid conditions,” said Stein.
Dr. Cody Meissner, professor of pediatrics at Dartmouth University, said he was “strongly opposed” to requiring a prescription because it limits patient choice.
“I think requiring a prescription is going to become a big barrier to administration of this vaccine. And if a person wants it for himself, herself, her children, they should be able to get it without a prescription,” said Meissner.
Pharmacist vaccination programs are widely considered a pivotal tool in widening access to vaccines, particularly for high-risk populations less connected to the healthcare system.
Doctor of Pharmacy Hillary Blackburn, a newly named member of the ACIP board, highlighted during debate that data from the 2024-2025 cold and flu season show that more than 90% of COVID-19 vaccine doses, more than 27.5 million shots, were provided at pharmacies.
Kelly Good, a liaison member representing the American Pharmacists Association, said requiring a prescription will create “healthcare inequities, especially for patients who may not have access to any other healthcare provider in their communities, and decrease individual patient choice.”
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“A prescription is not needed and will cause unnecessary steps to access pharmacists who are qualified to regularly assess risk and balance it with benefits for their patients,” Good said.
According to a 2025 study from the Journal of the American Pharmacists Association, nearly half of all COVID-19 vaccine doses given between December 2020 and September 2023 were provided through the Federal Retail Pharmacy Program, a program designed to maximize vaccine uptake during the pandemic. That equates to nearly 315 million COVID-19 vaccine doses administered during the first three years of the pandemic.
