- Medical groups teamed up to issue vaccine guidelines for COVID-19, influenza and respiratory syncytial virus, independent of federal guidelines.
- Why now: The CDC's advisory panel, ACIP, is in legal limbo after Kennedy fired its members and a judge blocked the replacements, creating a vacuum these medical groups are filling independently.
- Coverage and pharmacy dispensing rules vary by state, creating a patchwork that may affect who can get vaccinated where.
Just in time for updated flu, COVID-19 and RSV vaccines to hit pharmacies and doctors’ offices ahead of respiratory illness season, a number of leading medical groups have published their recommendations for who needs to have a vaccine.
The fall and winter respiratory virus season typically runs October through the middle of May.
Their advice, which was published in JAMA, the Journal of the American Medical Association, differs somewhat from the official guidance from the Trump administration, which came out at the end of August. The medical groups said they formed their recommendations after a careful examination of the latest evidence.
The American Medical Association teamed up with the Vaccine Integrity Project at the University of Minnesota to lead the consortium, which included reviews and buy-in on specific relevant recommendations by several groups: the American Academy of Pediatrics for guidance on vaccines for minors, the American College of Obstetricians and Gynecologists regarding vaccines during pregnancy, the Infectious Diseases Society of America for immunocompromised people and the American Academy of Family Physicians for adults and healthcare providers. They each published the guidance by subgroup separately, as well.
In a media briefing, Dr. Bruce Gellin, board chairman for the Vaccine Integrity Project, said the move was necessary because “unfortunately, today the federal government is not fulfilling that responsibility in the way that it historically has, but the need for the work has not disappeared.”
A chaotic time in vaccine history
The Centers for Disease Control and Prevention has a panel that is charged with making recommendations on vaccines, but that hasn’t happened because of legal issues. As Deseret News has reported, the Advisory Committee on Immunization Practices panel was fired last year and Health and Human Services Secretary Robert F. Kennedy Jr. selected seven new members, adding several others after that. Then a federal judge said he couldn’t do that and temporarily suspended their appointments and vacated their actions. The panel itself is in limbo, so no new recommendations have been made by it this year.
The judge also put on hold the guidance that those not on the approved list who want a vaccine have to talk to a healthcare provider. Many, including health experts, call the situation confusing. It’s worth noting that doctors can administer the shots off-label.
But without new ACIP recommendations, the federal flu guidance remains the same as last year’s.
For COVID-19
The collaborative has recommended the updated COVID-19 vaccine for all adults, with no carve-out for pregnancy or breastfeeding. Those older than 65 or who are immunocompromised should get a second dose.
For children, the groups suggest each child from 6 to 23 months old be vaccinated, as well as children 2 and older who have underlying medical conditions. They don’t take a position on children over 2, but Dr. James Campbell, chairman of the American Academy of Pediatrics’ infectious disease committee, told The New York Times it is appropriate if a parent wants the child to have it.
The medical groups note that the shots reduced the need for hospitalization or serious health impacts from the viral illness. They also noted no new safety concerns and said that, while possible, serious side effects are extremely uncommon, the benefits outweighing the risk for most people.
But as Deseret News wrote a few weeks ago, there are variations in terms of insurance coverage and state regulations regarding dispensing vaccines. “Most people head to local pharmacies for their COVID shots. And not all doctors have the vaccines on hand. Whether pharmacies will choose to administer shots off-label — or even whether their states allow it — could vary widely nationwide.”
No official federal advice has been given for COVID-19 shots, although the U.S. Food and Drug Administration approved the COVID-19 vaccines only for adults over 65 or those with a medical condition that might make them high risk. Others can get the vaccine after consulting their physician, who can administer the shots as he or she sees fit.
What about flu?
As for flu, the review of research found that vaccination reduces risk of serious illness. And the guidance is simple: Everyone 6 months and older should be vaccinated and for the best coverage. The best time to get the vaccine in terms of protection from influenza, per the groups, is by the end of October.
Per the CDC, “While vaccination by the end of October is recommended, vaccination should continue after October and throughout the influenza season as long as influenza viruses are circulating and unexpired vaccine is available.”
The CDC specifically urges the seasonal flu vaccine for those at high risk of complications or severe illness — and it’s a long list that includes children 6 months old to 5 years, anyone 50 and older, those with chronic conditions, those with weakened immune systems, women who are or will be pregnant in flu season, children and adolescents on certain medications who could experience Reye syndrome after an influenza infection, those in nursing homes or long-term care facilities, American Indian or Alaska Native people, and those with extreme obesity.
The FDA approved an mRNA flu vaccine — the first of its kind — for adults 50 and older in August. Healthline noted that in a clinical trial enrolling 40,703 adults 50 and older, people who received the mRNA vaccine had about 26% fewer cases of lab-confirmed flu-like illness than people who received a standard-dose shot,” based on the JAMA influenza review.
Respiratory syncytial virus
The federal government has thus far been silent on RSV guidance for the upcoming season.
But the medical-group collaborative said that adults 75 and older need a one-time RSV vaccine, as do those 50 to 74 who are at increased risk, according to the medical groups. Immunocompromised adults and adolescents should also be vaccinated, with the number and frequency of doses decided case by case, per the Times.
Women who are in their last trimester between September and March 1 are urged to get the vaccine so that their babies will be protected during RSV season, since RSV is very hard on infants. And if mom isn’t vaccinated while pregnant, infants under 8 months old should be given monoclonal antibodies. As for older infants, those 8 to 19 months at higher risk should be vaccinated their second season, whether they had a previous vaccination or not.