CDC Panel Changes COVID Vaccine Advice to Support Informed Decision-Making

The CDC’s acting director will decide whether to accept the recommendations.

A nurse carries a tray with a Pfizer-BioNTech COVID-19 vaccine at a health care center in Miami on May 29, 2025. Joe Raedle/Getty Images

The Centers for Disease Control and Prevention should recommend that people receive a COVID-19 vaccine only after speaking with a health care provider, agency advisers said on Sept. 19.

The Advisory Committee on Immunization Practices (ACIP) unanimously advised the CDC to change its immunization schedules to move COVID-19 vaccination to shared clinical decision-making.

For most tiers of recommendations on the schedule, the default decision should be to vaccinate the patient based on age group or other indication, unless contraindicated, the CDC states. “For shared clinical decision-making recommendations, there is no default.” Instead, vaccinations “are individually based and informed by a decision process between the health care provider and the patient or parent/guardian.”

ACIP provides advice to the CDC. The CDC’s acting director can choose to accept the advice, accept it after changing it, or reject it entirely. It’s not clear when that decision will happen.

The CDC in May stopped recommending COVID-19 vaccination for pregnant women and healthy children, under orders from Health Secretary Robert F. Kennedy Jr. It currently recommends that all adults other than pregnant women, as well as children who are moderately or severely immunocompromised, receive a COVID-19 vaccine.

The Food and Drug Administration recently rescinded emergency authorization for the vaccines and issued updated approvals. Those moves resulted in regulators clearing the vaccines for people aged 65 and older, as well as people aged six months to 64 years who have a risk condition as defined by the CDC.

The CDC usually updates its recommendations for COVID-19 vaccines in the summer, before the FDA approves shots with updated strains that target circulating variants. This year, officials decided to have the CDC’s advisers meet after the FDA’s moves.

Some states have issued their own guidance for COVID-19 vaccines. Oregon, Washington state, California, and Hawaii, for example, are recommending COVID-19 vaccination for all children ages 6 to 23 months, as well as all children “who choose protection.” And several outside groups have also released guidance that diverges from the CDC, prior to the advised changes.

Kennedy appointed all the members of ACIP.

Around 44 percent of people aged 65 or older received a COVID-19 vaccine in late 2024 or early 2025, according to CDC data. About 14 percent of adults ages 18 to 49, 13 percent of children, and a minority of health care workers received a vaccine during that time.

Workgroup Chair: Data Weak

The COVID-19 vaccines in late 2024 and early 2025 were estimated to provide people who were not immunocompromised 32 percent to 53 percent protection against hospitalization, according to CDC data. No estimates were provided for protection against infection.

Some members took issue with the estimates, noting that a percentage of the hospitalizations characterized as COVID-19-associated are actually driven by other causes, and patients merely test positive for COVID-19.

Retsef Levi, chair of ACIP’s COVID-19 immunization workgroup, said that the work group assessed the assessments of protection as being based “on very low quality data and analyses.”

According to a different analysis presented during the meeting, 1.1 million adults aged 18 to 49 without a risk condition, and 241,229 adults in that age range with a risk condition, need to be vaccinated to avoid one death. The numbers were 145,755 and 36,522 for middle-aged adults, and 14,818 and 5,642 for adults aged 65 and older.

Levi said the workgroup asked for and did not receive the actual number needed to vaccinate to avoid different outcomes, and pointed to a UK estimate that differs from the analysis. He also noted that levels of COVID-19 are lower this year than in years past, despite the lower vaccine uptake.

“Without significant change in vaccination rates, we see a major decrease in the incidence of COVID, which suggests that other factors are really driving this virus to fortunately be less virulent and cause less harm,” he said.

Safety Data

Another presentation focused on data indicating that COVID-19 vaccination alters the immune system of a recipient, potentially causing problems such as increasing vulnerability to other viruses.

The CDC said in a presentation that no new safety signals have emerged for updated formulations of the vaccines.

Levi countered by highlighting autopsies that identified deaths as being caused by COVID-19 vaccination, including among children.

“Myocarditis can cause death. It’s proven,” he said.

Dr. Henry Bernstein, an outside expert presenting the view of a minority of the workgroup, said that introducing a prescription requirement would create barriers to COVID-19 vaccination. He said a simple, stable recommendation is better because it can increase vaccine coverage.

Prescriptions?

ACIP also considered advising state and local officials to require a prescription for COVID-19 vaccination.

Members supportive of the motion said they wanted to make sure people engage in nuanced discussions before receiving one of the shots.

“I’m a very big proponent of informed consent,” Dr. Evelyn Griffin said. “And I feel that getting a prescription would require that, or necessitate that interaction with a provider that can discuss informed consent, much like getting a blood pressure medication refilled or started.”

Catherine Stein, another member, was among the no votes.

“I’m really concerned about the requirement of a prescription because I believe the segment of the population that is under-insured has a lack of access to healthcare. They’re going to be unable to get a prescription,” she said. “And those are the people that are at higher risk of a lot of the comorbid conditions.”

The vote was 6–6. Martin Kulldorff, who voted no, broke the tie, so the motion failed.

Kulldorff had said earlier that the motion would not have required prescriptions.

“We don’t have power over prescriptions,” he said. “That is a state issue.”