CDC panel says no to prescriptions for COVID vaccines

This story has been updated to include the vote regarding COVID vaccines.

In a tiebreaker vote, the panel that advises the Centers for Disease Control and Prevention on vaccine recommendations decided Friday that a prescription should not be required to receive a COVID-19 vaccine. That will likely make it easier for pharmacists to continue to administer COVID-19 shots.

With six votes for and six votes against recommending that state and local governments require a prescription, committee Chair Martin Kulldorff cast the vote that sank the proposal.

But COVID-19 vaccine access has already been weakened by earlier Food and Drug Administration approval only for those over 65 of younger people with medical conditions that increase risk of severe illness.

Earlier Friday, the CDC panel also voted to leave unchanged guidance on when or if newborns receive a hepatitis B vaccine. At least in the near term, babies will still routinely be given the vaccine within 24 hours of birth.

The panel did vote 8-3 with one abstention to change the guidance on the combined MMRV vaccine, which provides vaccination against measles, mumps, rubella and varicella, the technical name for chickenpox.

The committee was more unified on other COVID decisions, though the discussion was often heated. Ultimately, panelists of the Advisory Committee on Immunization Practices agreed that better informed consent and joint decision-making with a health care provider should be emphasized.

Whether the “joint clinical decision-making” will weaken the ability to get a COVID-19 vaccine is unclear, since it implies people should see a qualified health care provider before deciding on vaccination.

And the committee’s recommendations still must be approved by the acting director of the CDC.

The membership of the Advisory Committee on Immunization Practices is new, some of the members even appointed just this week by Health and Human Services Secretary Robert F. Kennedy, who dismissed the existing panel a few months ago. There has been speculation that the committee, which includes a number of vaccine-wary members selected by Kennedy, who has spoken often of his own skepticism, would remake the vaccination landscape in America to the delight or horror of experts and citizens, depending on their own vaccine views.

The two-day meeting in Atlanta, where CDC is headquartered, was the group’s first chance to actually vote on guidance that will be given to the acting CDC director for approval, the next step before the panel’s recommendations become the official public health guidance on vaccines. What will happen next is less clear than usual, given unusual levels of disagreement on vaccine policy under Kennedy.

Lots of vaccine disagreements

There are very large fissures this year, after the Food and Drug Administration indicated a number of changes to its recommendations on who can and can’t have the COVID-19 vaccine, including removing healthy children and adults under the age of 65 from guidance, as Deseret News earlier reported. And the American Academy of Pediatrics put together its own vaccine guidance in anticipation of disagreeing with federal guidance.

States have also taken sides. Florida officials said they would eliminate all vaccine mandates, while at least two coalitions of blue states have announced plans to develop their own vaccine policy outside of federal guidance.

Meanwhile, Kulldorff said ACIP is forming a pair of working groups. One will look at vaccine recommendations specifically for during pregnancy. The other will look at shot timing for the vaccine schedule.

Decisions by the committee are consequential.

The Vaccines for Children program, which inoculates millions of U.S. children who do not otherwise have access to vaccines, relies on ACIP recommendations. Health insurers are required to cover the cost of vaccines recommended by the CDC based on the panel’s recommendations, if the CDC director approves them. And pharmacists in many states, including Utah, are allowed to administer recommended vaccines. CDC guidance influences care providers, too, as medical groups and the CDC have traditionally been in agreement.

But health insurers are likely to cover the cost of the discussed vaccines, including the MMRV vaccine, if parents and doctors want it to happen. AHIP, a national trade association of health insurance providers, issued a press release Sept. 16 that said its member insurance companies “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 is the group’s name; it was formerly America’s Health Insurance Plans.

That means last year’s recommendations will be covered, regardless of guidance issued by the committee this week. Since not all insurers belong to AHIP, it’s a good idea to check with your insurance. And it won’t impact what government insurance programs like Medicare, Medicaid and CHIP cover. That remains to be seen.

COVID-19 recommendations

Besides the prescription vote, the panel said that immunization schedules for administration of FDA-approved COVID-19 vaccines should be updated with the recommendation that adults 65 and older be vaccinated “based on individual-based decision-making,” synonymous with “shared clinical decision-making.” Those ages 6 months to 64 years should use the same basis to decide, “with an emphasis that the risk-benefit of vaccination is most favorable” for those at increased risk of severe illness and lowest for those without increased risk.

The panel also agreed the CDC should “engage in an effort to promote more consistent and comprehensive informed consent processes,” including describing six risks and uncertainties that were presented to the panel during the two-day meeting. Those would be among factors discussed by clinical providers and would be included in the paperwork informed consent signed to receive a vaccine.

The final COVID-19 vote centered on conversations with authorized health care providers to discuss individual risks and benefits of the vaccine, including known risks for severe outcomes of COVID-19 itself, as well as the risks of the vaccines and a discussion of what’s uncertain.

MMRV vote

Thursday afternoon, the ACIP panel voted 8-3 to do away with the recommendation that children under 4 can receive the combined MMRV shot. That only affects about 15% of those children, as the vast majority receive MMR and chickenpox vaccinations separately.

Some appreciate a single shot. Others felt that the slightly elevated risk of fever-related seizures in children ages 1 to 2 should put that combination shot out of reach for young children, though not all ACIP members saw that as a significant health risk.

ACIP member Dr. Cody Meissner, a Dartmouth College pediatrician, said seizures triggered by fever are not unusual. He said all pediatricians have seen them and “we know that the prognosis is excellent.”

The vote was actually somewhat confusing, because the panel removed the recommendation for the combined vaccine for those under 4, but voted 11-1 to allow the combined vaccine to be covered by the Vaccines for Children program. Kulldorff cast the dissenting vote. Friday morning, the committee reversed that, voting so low-income children under age 4 will not be able to get the combined vaccine in that program.

Hepatitis B vaccine (non)vote

The hepatitis B shot has for decades been given to all infants at birth. Critics of existing policy have said only babies whose mothers have hepatitis B need to be vaccinated, while supporters including the American Academy of Pediatrics note that not all women are screened for hepatitis B and giving the vaccine to all babies prevents chronic hepatitis and its complications for those who might otherwise fall through the cracks.

Sen. Bill Cassidy, R-La., was outspoken Wednesday on the need to continue providing the hepatitis B vaccine to newborns. “We have decreased from 20,000 kids a year getting hepatitis B to 20 kids a year. That’s exponential decline,” Cassidy, a liver specialist, told reporters after a hearing of the Senate Health, Education, Labor and Pensions committee on the termination of former CDC director Susan Monarez.