Shifts in CDC Policy on COVID-19 Vaccination for Children Dilute Protection for the Vulnerable Population, ID Specialist Warns

"As you know, of the hospitalizations and deaths in the pediatric age group that occurred last year, over half occurred in perfectly healthy children."

The comment above, from infectious disease specialist, vaccine expert, and public health and policy advocate William Schaffner, MD, came at the end of the answer to a question about what changes in vaccine recommendations primary care clinicians should be aware of and plan for as respiratory virus season 2025-2026 draws closer.

Implicit in his final sentence is commentary on the removal from the CDC's recommended immunization schedule of COVID-19 shots for healthy children and pregnant women. The change was among the first and most significant in a series of revisions to vaccine precedent set in motion by newly appointed Health and Human Services Robert F Kennedy, Jr.

As medical professional associations seek to counter what are believed to be dangerous shifts in immunization policy by releasing recommended schedules of their own, Schaffner urged pediatricians, primary care and family clinicians to avoid confusion by hewing to the school admission immunization requirements established by their state's health departments. That will cover the back-to-school scenario.

What About "Flu" Season?

Looking to the upcoming months when illness from influenza, COVID-19, RSV, and other respiratory viruses swells and peaks in the northern hemisphere, Schaffner said that some recommendations have gotten "murkier."

Everyone from the age of 6 months should receive an annual, updated flu shot, and that recommendation is clear cut, he said. An updated vaccine against SARS-CoV-2 is also available. On May 27, HHS Secretary RFK, Jr, directed the CDC to remove guidance endorsing the COVID-19 shot during pregnancy and to alter language "regarding healthy children from a recommendation for routine administration to a statement that the vaccine may be administered if desired by parents and informed by shared decision making with their clinician." (Note: The vaccine remains recommended for any child or adult with underlying health conditions that place them at increased risk for severe infection with COVID-19.)

In the short video above, part of a longer interview with Patient Care,© Schaffner encourages parents who want to protect their children with vaccination against COVID-19 to do so. And then he reminds listeners about the vulnerability of even "perfectly healthy children."

The following transcript has been lightly edited for style.

Patient Care: We are about to enter back-to-school season. In some states, children are already heading back, and respiratory virus season 2025–26 is within view. What are the most important changes to vaccine guidance that primary care and family physicians should be aware of and plan for?

William Schaffner, MD: Well, the first thing I’d say, Grace, is that we ought to remember every state has school admission immunization requirements. Practitioners should continue to promote and explain those to parents. If we adhere to those, we can ensure a maximum number of children are vaccinated.

As for the upcoming respiratory virus season, we will have an updated influenza vaccine. Those recommendations remain unchanged: if you’re 6 months of age or older, avail yourself of the vaccine. That includes all the schoolchildren we just mentioned.

We’ll also have an updated COVID vaccine available. The recommendations there are a bit murkier and somewhat confusing, but the guidance that children with underlying chronic medical conditions should be vaccinated remains secure. Parents who wish to vaccinate their otherwise healthy children are also permitted and encouraged to do so, because, as you know, of the hospitalizations and deaths in the pediatric age group that occurred last year, more than half were in perfectly healthy children.

William Schaffner, MD, is professor of preventive medicine with a primary appointment in the department of health policy and a professor of medicine in the division of infectious diseases at the Vanderbilt University School of Medicine, in Nashville, TN. Schaffner is past medical director of the National Foundation for Infectious Diseases (NFID) and formerly served as NFID liaison to the ACIP at the Centers for Disease Control and Prevention (CDC). He is also a past president of NFID.

For more of our conversation with Dr Schaffner, see:

What's the Mood Among Infectious Disease Experts Right Now? We Asked William Schaffner, MD

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The ACIP's Rich History of Debate is in Jeopardy, Not A Good Sign for Science, ID Expert Says