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With another infectious diseases season upon us, the vaccine picture could not be more challenging.
While the flu vaccine is widely available, the Centers for Disease Control and Prevention (CDC) – which had been locked in a battle with its boss, Health and Human Services Secretary Robert F. Kennedy Jr., over vaccine policy – has only recently issued final guidelines for the Covid-19 shot.
On Monday, Oct. 6, the Centers for Disease Control and Prevention (CDC) announced an “individual-based decision-making approach” to Covid-19 vaccination.
The immunization schedules adopt recent recommendations by the CDC Advisory Committee on Immunization Practices (ACIP) — a panel picked by Kennedy — which were approved last week by Acting Director of the CDC and Deputy Secretary of Health and Human Services Jim O’Neill.
“Informed consent is back,” O’Neill said. “CDC’s 2022 blanket recommendation for perpetual Covid-19 boosters deterred health care providers from talking about the risks and benefits of vaccination for the individual patient or parent. That changes today.”
The Health and Human Services website added: “ACIP’s recommendation emphasized that the risk-benefit of vaccination in individuals under age 65 is most favorable for those who are at an increased risk for severe Covid-19 and lowest for individuals who are not at an increased risk, according to the CDC list of Covid-19 risk factors. The U.S. Food and Drug Administration has approved marketing authorization for Covid-19 vaccines for individuals who have one or more of these risk factors, as well as for individuals age 65 and older.
“Individual-based decision-making is referred to on the CDC’s immunization schedules as vaccination based on shared clinical decision-making, which references providers including physicians, nurses and pharmacists. It means that the clinical decision to vaccinate should be based on patient characteristics that unlike age are difficult to incorporate in recommendations, including risk factors for the underlying disease as well as the characteristics of the vaccine itself and the best available evidence of who may benefit from vaccination.”
These recommendations differ from the American Academy of Pediatrics (AAP) and the Infectious Diseases Society of America (IDSA), which recommend the Covid shot for children ages 6 months to 2 years, who, they said, are in a high risk category and whose parents are now having trouble finding pediatric doses.
Meanwhile, many blue states with Democratic governors have sought to make an end-run around what they see as vaccine limitations – while addressing the limitless nature of infectious diseases, which transcend borders — by forming health-care consortiums of neighboring states. New York and Connecticut are part of the Northeast Public Health Collaborative, created in September. (It also includes New Jersey, Pennsylvania, Massachusetts, Rhode Island and Maine.)
On Sunday, Oct. 5, Gov. Kathy Hochul (D-New York) announced an extension of Executive Order 52, which allows pharmacists to continue administering Covid vaccines, providing access for all New Yorkers who wish to be vaccinated. The executive order will be in place for at least another 30 days while work continues on a long-term legislative solution.
She has also called on the federal government to make the Covid vaccine accessible through the Vaccines for Children (VFC) program. (As of now, the Trump Administration has not made the Covid vaccines available for states to order through its VFC program.) Hochul has directed the New York state Department of Health to explore additional solutions to ensure all children have access to the vaccines.
In September, Gov. Ned Lamont (D-Connecticut) announced a similar series of executive actions to ensure accessibility and insurance coverage for all those who want to be vaccinated in his state.
AHIP (America’s Health Insurance Plans), a trade and advocacy group representing insurers, has posted a statement saying: “Health plans will continue to cover all ACIP-recommended immunizations that were recommended as of Sept. 1, 2025, including updated formulations of the Covid-19 and influenza vaccines, with no cost-sharing for patients through the end of 2026.” That means that those ages 6 months and older are covered for the Covid shot.
Medicare, Medicaid and other government health plans also cover these vaccines.
In its post on the CDC immunization schedule, HHS explained the reason for its new guidelines: “Unlike the Covid-19 primary series vaccination pioneered by Operation Warp Speed (OWS) that reached an estimated nearly 85% of the U.S. adult population, just 23% of adults followed the CDC’s most recent seasonal booster recommendation according to its National Immunization Survey. The booster shots prompted widespread risk-benefit concerns about their safety and efficacy as the Covid-19 virus became endemic following population-wide immunity acquired during the pandemic and OWS.”
But both the Cleveland Clinic and the Mayo Clinic have reported that population immunity — also known as herd immunity, which is 95% — is unlikely to be achieved with mutating viruses like Covid and influenza. The purpose of such vaccinations is to mitigate against any virus-caused illness and a possible epidemic, said Rafael E. Torres, M.D., chief quality officer at White Plains Hospital.
Torres has undoubtedly seen many an infectious disease in his career, having extensive experience in emergency medicine. Prior to becoming chief quality officer, he was director of emergency medicine at White Plains Hospital, part of the Montefiore Health System. He studied at Johns Hopkins; received his medical degree from George Washington University School of Medicine, where he earned honors for academic achievement; and completed his residency in emergency medicine at New York-Presbyterian Brooklyn Methodist Hospital, where he was chief resident and honored as Resident of the Year.
“I think with any vaccine if there was 100% certainty that you would not contract the illness, more people would be open to it,” Torres added. “With that said, even partial protection has enormous value in reducing illness and transmission. The chance of illness is never zero, but a vaccine makes it less likely. Even in cases where full immunity isn’t achieved, the vaccine still significantly reduces the likelihood of contracting the disease or having a severe outcome.
“Herd immunity is not about eliminating risk completely but lowering it dramatically. The concept behind herd immunity is that if the overwhelming majority of people are protected, those who are more vulnerable but are unable to be vaccinated then become less likely to contract a communicable disease.
“I think that we all come at this from the same angle, which is trying to keep ourselves, our families and our communities safe. If we look at it from that point of view, we can certainly do that together.”
Other vaccine news
Also in the spotlight in the HHS post – the MMR shot for measles, mumps and rubella, once again being studied for links to autism that have long been debunked. The CDC still recommends the MMR vaccine, but it has rescinded recommendation of the MMRV vaccine, a combined shot for measles, mumps, rubella and chickenpox (varicella), for children under age 4 as it has been linked to fever-induced seizures.
Meanwhile, President Donald J. Trump has weighed in skeptically on the hepatitis B vaccine for babies, who can get the disease, which may cause lasting liver damage, during birth. Trump would prefer to see children get the hep-B vaccine at age 12.
“Childhood vaccinations and boosters for those who have waning immunity have saved millions of lives,” said White Plains Hospital’s Rafael E. Torres, M.D. “They provide protection not only for the individual, but also for the community at large, especially for those who are not able to get vaccinated or who respond less appropriately to vaccination, including the extremely young, the elderly or the immunocompromised.”
For more, visit cdc.gov.
