The CDC's vaccine advisors are considering options that would narrow the recommendations for the fall COVID vaccine to only include groups at higher risk for severe illness.
The news came at a Tuesday meeting of the Advisory Committee on Immunization Practices (ACIP), the first of a 2-day session that was originally scheduled for February but abruptly postponed by HHS.
Seasonal COVID shots are currently recommended for everyone 6 months and older, but CDC's Lakshmi Panagiotakopoulos, MD, MPH, presented findings from a recent poll of the ACIP COVID-19 Work Group showing that 76% of its members supported a non-universal (risk-based) recommendation for the 2025-2026 respiratory virus season.
"I guess I am surprised we're considering a risk-based recommendation," said ACIP member Denise Jamieson, MD, MPH, of the University of Iowa's medical school.
She worried it will be harder to implement, and may cause more headaches for patients who want to get shots and have them covered by insurance.
According to estimates, 74% of U.S. adults have at least one condition placing them at higher risk for severe illness, whether that be age, a chronic illness, or an immune-compromising condition.
In the April 3 poll on non-universal policy options, 84% of the work group members supported COVID vaccine recommendations for specific conditions and exposures, 84% supported a universal recommendation for certain age groups (e.g., those 65 and up), and 89% said they supported having the vaccines available for anyone wanting protection.
Jamie Loehr, MD, of Cayuga Family Medicine in Itasca, New York, said he is happy the committee is considering a risk-based recommendation but also worried about feasibility and the message it would send.
"COVID is still a fairly dangerous disease and very, very common," he said. "We are not talking about 10 cases of mpox. We are talking about thousands of hospitalizations and deaths."
Data presented by CDC officials at the meeting showed the waning severity of the coronavirus pandemic. For example, COVID-19 dropped from the third leading cause of death among U.S. adults in 2021 to the 12th spot in 2023. And hospitalization rates fell from a peak of about 500 per 100,000 population in 2020-2021 and 2021-2022 down to about 60 per 100,000 in the 2024-2025 season.
From October 2024 to March 2025, children and adolescents comprised about 4% of COVID-related hospitalizations, with the highest rates among those younger than 6 months of age. More than half (59%) of those hospitalized had at least one underlying medical condition.
ACIP member Charlotte Moser, MD, of Children's Hospital of Philadelphia, said she favors the idea of a risk-based approach to COVID-19 vaccination. "I'm glad we're exploring that, [but] we need to keep the youngest of children on our radar because they represent a large group that's susceptible to the virus every year," she said. "If we can vaccinate those kids, we may be able to decrease the under 1-year-old hospitalization rate, and we may also protect them against long COVID."
Only 23% of adults and 13% of children received the 2024-2025 COVID shot, according to CDC data.
Among adults, vaccine effectiveness (VE) estimates for 2024-2025 ranged from 30% to 33% against COVID-associated emergency department visits or urgent care encounters. VE against associated hospitalizations among immunocompetent adults age 65 and older ranged from 42% to 48%, while the rate for their immunocompromised counterparts was 40%.
"VE should be interpreted as the added benefit of 2024-2025 COVID-19 vaccination in a population with high levels of infection-induced immunity, vaccine-induced immunity, or both," said Ruth Link-Gelles, PhD, MPH, of the CDC.
A vote on risk-based recommendations could come at the next committee meeting, scheduled for June.
ACIP members on Tuesday also heard details about the recently approved FluMist for self- or caregiver administration, expected to be available for the 2025-2026 influenza season. A vote on the vaccine was originally scheduled for the February meeting but removed from the April agenda.
Following a recent study suggesting the latest flu shot was associated with a higher rate of infections among healthcare workers, CDC officials presented data showing that the 2024-2025 vaccine had a VE in children ranging from 32% to 60% in outpatient settings and 63% to 78% in inpatient settings.
In comparison, VE among adults was slightly lower, at 36% to 54% in outpatient settings and 41% to 55% in inpatient settings.
"These estimates show that influenza vaccine reduced the risk for medically attended influenza outpatient visits and hospitalizations among children and adolescents and adults across 23 U.S. states," said CDC's Aaron Frutos, PhD, MPH.
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