Feb 24, 2021
A COVID-19 vaccine being administered at the Labcorp mass vaccination site in Natick. (Pool photo by Matthew Stone/Boston Herald)

A WEEK AGO, the CDC’s acting director signed off on the recommendations made by the Advisory Committee on Immunization Practices (ACIP), an external panel that sets US vaccine policy. The committee voted to recommend that COVID-19 vaccines, previously recommended as an annual shot for everyone over the age of 6 months, be taken only after discussion with a health care provider. They further emphasized the importance of a risk-based discussion of whether to get vaccinated for individuals under the age of 65.   

Six of 12 members also voted to require a prescription for vaccination, a motion that failed based on protocol, but which reflected the distrust of COVID-19 vaccines that committee members had been voicing throughout the day-long meeting.   

Professional societies and public health experts have, justifiably, reacted with disapproval both to the way the meeting unfolded and to the wording of the recommendations. The 2025-2026 CDC guidelines are, for the first time, at odds with those of the American Academy of Pediatrics, the American College of Obstetrics and Gynecology, and the American Academy of Family Physicians.   

An alliance of Western states and a collaborative of Northeastern states each released their own guidelines just before the ACIP meeting, intentionally preempting CDC, the inevitable confusion from disparate recommendations a small price to pay compared to the chaos that they anticipated might occur if pharmacies and insurance companies stopped administering and covering, respectively, COVID-19 vaccines for large swaths of the population who want them.   

The Department of Health and Human Services, under the current administration, has repeatedly claimed that its more measured approach to vaccine recommendations is intended to restore public trust– in vaccines and in public health in general. This may or may not work, but one thing is certain: They are losing the trust of the scientific community. In the latest two rounds of ACIP meetings, presentations were made by non-experts, discussions lacked scientific rigor, and decisions were not always evidence based.  

But there’s an ironic story here that’s not being told: CDC and the ACIP under the previous administration were already planning to scale back COVID-19 vaccine recommendations.   

In April, the previous roster of ACIP members, who had served under President Biden, convened a meeting that had been postponed from February. The COVID-19 ACIP work group presented a summary of its offline discussions. Made up of ACIP members, government health agency officials, CDC employees, and liaisons from relevant professional societies, the work group introduced the rationale behind a new proposal to narrow vaccine recommendations from the current “universal” approach (in which all individuals over the age of 6 months are recommended to receive vaccines annually) to targeting high-risk individuals only.   

Arguments for a change to a risk-based approach included the continued decrease in the risk of COVID-19 hospitalizations and deaths,  high rates of immunity, and the declining incidence of long COVID.   

They argued that the low rates of vaccination in the US indicate a lack of trust in recommendations around COVID-19 vaccination. And they presented a chart comparing US policy to that of other countries and the World Health Organization, highlighting the fact that the US is an outlier in its universal vaccination stance. In a survey of the group, 76 percent were in favor of a shift to risk-based vaccination recommendations.  

ACIP was to vote on this move away from universal vaccination in June. By then, though, all 17 members of the committee had been terminated. The COVID-19 vote was postponed to September, a decision which led to weeks of uncertainty due to the lag time between when the new formulation of the vaccine was approved by the FDA and the release of official guidelines for its use, all while Health and Human Services appeared to be issuing new vaccine policy via social media posts.  

Today, we have new vaccine recommendations from CDC, but they are accompanied by a growing rift between the agency and medical doctors, scientists, and public health authorities. Had the process been allowed to play out—with the original cadre of ACIP members voting in June—we might have guidelines today that are not so different from the new ones we just received, perhaps even more clearly outlining which populations are low risk.   

I agree that risk-based recommendations have the potential to increase public trust, but not without the backing of the scientific and public health community. Now, instead of trust, we have chaos.  

Shira Doron, MD, is the chief infection control officer for Tufts Medicine and the hospital epidemiologist at Tufts Medical Center. She is a professor of medicine at Tufts University School of Medicine.