Updated schedule for Covid-19 vaccinations endorses inoculations for children, albeit with a distinct classification
The Centers for Disease Control and Prevention (CDC) has revised its immunization schedule for children, following the announcement by US Health and Human Services (HHS) Secretary Robert F. Kennedy Jr. that Covid-19 vaccines would be removed from the list of recommended shots for healthy children and pregnant women.
Under the updated guidelines, children can receive Covid-19 vaccines following a consultation with a healthcare provider, a practice known as "shared decision-making." However, for pregnant women, there is less guidance; spaces advising this group on the Adult and Child Immunization Schedules are now shaded gray for Covid-19 vaccines, indicating no recommendation.
The new guidance has created confusion among doctors, parents, and vaccine experts as they seek to interpret the new language. The changes, posted two days after Kennedy's surprising social media announcement, have further complications as Kennedy tries to balance appeasing vaccine-skeptical supporters while listening to expert advice and the majority of Americans who want access to vaccines.
HHS insists that the vaccines were removed from the CDC's recommended vaccine schedule, as Kennedy had pledged. However, two sources familiar with the schedule's designations and language have clarified that Covid-19 vaccines remain on the schedule for children and adults, although there is no specific recommendation for pregnant women.
"All this demonstrates that DHHS doesn't understand how the vaccine schedule works," one source said.
On the updated Child and Adolescent Immunization Schedule, Covid-19 vaccines are no longer listed as "recommended" but are listed as "recommended vaccination based on shared clinical decision-making." This means that children can still get the shots after consulting with a health care provider, as is the case for other vaccines with similar classifications.
"Yes, absolutely they are still on the schedule," said a source familiar with the agency's vaccine recommendations who asked not to be named.
In meetings with HHS officials over the past two days, CDC officials have reportedly been deferential and professional, with no confrontation about the recommendations. The updated CDC recommendations align with Kennedy's language from earlier in the week, when he said that the Covid-19 vaccine for healthy children and pregnant women had been removed from the CDC's recommended immunization schedule.
The changes to the Covid-19 vaccine policy for children and pregnant women in the US may impact individuals differently. According to HHS, the old COVID-19 vaccine recommendations for healthy children under 18 and for pregnant women have been removed from the CDC vaccine schedule. Parents and healthcare providers are now encouraged to discuss any personal medical decisions regarding Covid-19 vaccination.
Under shared clinical decision-making, patients must consult with a healthcare provider to assess the benefits and risks of the vaccine. A healthcare provider who routinely administers vaccines, such as a doctor, nurse practitioner, nurse, or pharmacist, would be available to discuss the vaccine with patients. A vaccine listed on the schedule in this category is required to be covered by insurance with no cost-sharing, meaning no co-pays for patients.
The CDC has clarified that the updated recommendation applies to all children ages 6 months through 17 years, including those who are moderately or severely immunocompromised. Children eligible for free vaccines through the Vaccines for Children program will also be able to get Covid-19 shots after a conversation with their health care provider.
Experts have expressed relief that children can still receive the shots despite the change in policy. However, shared clinical decision-making can present hurdles to vaccination because it requires doctors to consult with patients first.
"With shared clinical decision-making, historically, it has been harder to get people vaccinated," said Dr. Michelle Fiscus, a pediatrician who is chief medical officer for the Association of Immunization Managers.
The future of Covid-19 vaccine access for pregnant women is less clear, as many CDC information pages continue to recommend the Covid-19 vaccine for pregnant women. However, the adult immunization schedule has been changed to specify that the recommendation applies only to adults who aren't pregnant. The lack of guidance for pregnant women seems to contradict recent statements from the US Food and Drug Administration, which has indicated that vaccines would continue to be approved for adults with underlying conditions, including pregnancy.
Pregnancy is a risk factor for severe Covid-19 infections. Early in the pandemic, CDC studies found that pregnant women with Covid were three times more likely to need intensive care and nearly twice as likely to die compared to those who weren't pregnant. Covid infections during pregnancy have also been linked to fetal complications, such as stillbirth and preterm delivery.
The Society for Maternal-Fetal Medicine has stated that it will continue to recommend that people who are pregnant be vaccinated against Covid-19. "Maternal immunization remains the best way to reduce maternal, fetal, and infant complications from COVID-19 infection, and is safe to be given at any point during pregnancy," the group said in a statement.
In the revised guidelines, Covid-19 vaccines for children are still accessible through shared clinical decision-making, a process where children can get the shots after consulting with a healthcare provider. However, for pregnant women, the updated Adult and Child Immunization Schedules imply no specific recommendation for Covid-19 vaccines, causing confusion and contradictions with recent statements from the US Food and Drug Administration that vaccines would continue to be approved for adults with underlying conditions, including pregnancy.
