Medical groups issue joint vaccination guidance amid federal uncertainty

As the fall respiratory virus season approaches, several leading S. medical organizations have issued coordinated vaccination guidelines, stepping in to provide what they describe as clear and consistent advice in the absence of updated federal recommendations.

The American Academy of Pediatrics, the American Academy of Family Physicians, the American College of Obstetricians and Gynecologists, and the Infectious Diseases Society of America each released guidelines on Wednesday for their patient populations, covering influenza, COVID-19, and respiratory syncytial virus (RSV). The groups say they hope to ease confusion caused by the changing approach of the Trump administration to vaccine recommendations.

"There's been a lot of confusion and chaos regarding vaccine recommendations," said Dr. Sandra Fryhofer of the American Medical Association. The AMA is collecting the groups' recommendations, along with evidence on vaccine safety and effectiveness, on a website, org, so that "the public has clear, consistent, science-based guidance even while the federal process is in flux," she said.

Influenza recommendations

The medical societies agree that just about everyone starting at age 6 months should receive a flu vaccination. Influenza is particularly dangerous for people 65 and older, pregnant women, young children, and people with chronic health conditions such as asthma or diabetes, they note. The last two flu seasons were especially harsh, with unusually high numbers of child deaths, the vast majority in unvaccinated children.

The groups highlight that flu vaccines reduce older adults' hospitalizations by 31%, according to the Vaccine Integrity Project, an independent initiative based at the University of Minnesota. Three "enhanced" flu vaccines are designed to better protect seniors, and the American Academy of Family Physicians urges older adults to choose one of those.

For people ages 50 and older, a new option is available this year: the first flu vaccine made with mRNA technology, which the FDA approved. One study found that Moderna's mFlusiva was 27% more effective against symptomatic illness among 50- to 64-year-olds than a standard flu shot. The shot's side effects occurred somewhat more often than with standard flu shots.

The shot-averse can choose a nasal spray, FluMist, if they are ages 2 to 49 and meet other health criteria.

The American Academy of Pediatrics recommends an annual flu shot for everyone ages 6 months and older. October is considered ideal for getting a flu vaccine, as influenza typically starts spreading in November.

COVID-19 guidelines

The medical groups' COVID-19 recommendations go beyond current federal advice. The FDA has only formally approved COVID-19 shots for higher-risk people: those ages 65 and older or younger people with at least one health condition that increases risk. However, the American Academy of Family Physicians recommends all adults get a COVID-19 vaccination, with adults 65 and older receiving a fall dose and then a second dose six months later.

The American Academy of Pediatrics recommends a COVID-19 shot for all children ages 6 months to 23 months and for older children with high-risk conditions. It also supports vaccination for any child whose parent wishes it.

The American College of Obstetricians and Gynecologists urges COVID vaccination for pregnant women, as well as for those considering getting pregnant or breastfeeding. Dr. Christina Davidson of ACOG said there is no evidence that coronavirus vaccination during pregnancy increases the risk of miscarriage or other problems, and that the vaccines "not only protect mom's health but also protect the newborn."

People can choose a shot from Moderna, Pfizer, or Novavax and Sanofi. Independent analyses released Wednesday, published in the journal JAMA, found the latest COVID-19, flu, and RSV vaccines remain very safe and highly effective. The Vaccine Integrity Project said last fall's COVID-19 shots cut the risk of hospitalization by 53% in seniors and reduced emergency room visits for very young children.

Common side effects for flu and COVID-19 vaccines are mild and temporary, such as sore arms, fatigue, headaches, muscle aches, and mild fever.

RSV guidance

RSV typically causes cold-like symptoms during the fall, winter, and early spring. The American Academy of Family Physicians recommends a one-time RSV vaccination for adults 75 and older, people ages 50 to 74 who are at increased risk, and younger people with weakened immune systems. The American Academy of Pediatrics recommends a vaccine-like medication for high-risk infants and has broadened its recommendation for RSV immunization to include infants and children ages 8 to 19 months entering their second season.

Why the guidance is needed

The CDC's process for issuing vaccine guidelines was frozen by a lawsuit that blocked the Trump administration's efforts to reduce the number of vaccines children routinely receive. Health and Human Services Secretary Robert F. Kennedy , a longtime vaccine critic, tried to cut the number of federally recommended routine vaccines, a move President Trump recently tried to revive. Trump and Kennedy claim children receive too many vaccines at once and that immunizations are linked to autism, a claim disputed by most doctors, public health authorities, and infectious disease experts.

The CDC did not respond to questions about any new fall guidance. Neither the Department of Health and Human Services nor the CDC responded to NPR's request for comment. The CDC extended its 2025 flu vaccine recommendations to this year.

Officials and experts have voiced concern about the situation. Dr. Demetre Daskalakis, who resigned last year as director of the CDC's National Center for Immunization and Respiratory Diseases, told NPR: "The bottom line is that this is dangerous." Jennifer Kates of KFF said: "It's unprecedented that we're in this situation." Jason Schwartz of Yale University said: "There is no substitute for the kind of clear, coherent messages and communication that the CDC has provided for decades."

Bruce Gelin of the Vaccine Integrity Project said: "Unfortunately today, the federal government is not fulfilling that responsibility in the way that it historically has. We cannot allow the breakdown of the federal process to create a vacuum in evidence-based vaccine guidance."

Practical implications

Pharmacies are common places to receive flu and COVID-19 shots. Walgreens says it offers those shots without a prescription in all but two states, Arizona and Oregon. Most states have decoupled the ability of pharmacists to administer the shots from federal guidelines and often rely on the recommendations of medical groups, according to reporting by NPR.

Medicare covers the fall shots, and most private health insurers say they plan to continue covering them through 2027. The Vaccines for Children Program is still expected to supply the immunizations for eligible children. Brigid Groves of the American Pharmacists Association told NPR: "It should be business as usual."

Dr. Sarah Nosal of the American Academy of Family Physicians said: "The bottom line is that vaccines are one of the country's greatest success stories."