Should your baby receive a COVID-19 vaccination? The answer is no longer as straightforward or universally agreed upon as it once was. In an uncommon move, the American Academy of Pediatrics (AAP) is advocating a distinct approach to childhood immunization compared to the U.S. Centers for Disease Control and Prevention (CDC).
While both organizations concur that families, in consultation with their physicians, should decide whether to vaccinate their children, the AAP adopts a more definitive position for the youngest eligible U.S. children, advocating for all of them to receive COVID-19 vaccinations.
The CDC’s position on COVID-19 vaccines for healthy children aged over six months originated following guidance from Robert F. Kennedy Jr., the Secretary of the Department of Health and Human Services, in May. However, the CDC does endorse the shot for children who are moderately or severely immunocompromised.
The day after the AAP issued its recommendations, Kennedy publicly criticized the organization, alleging they permitted pharmaceutical company donors to influence their guidance. The AAP, however, asserts that its recommendations are grounded in scientific evidence.
Here is key information regarding the differing guidance on COVID-19 vaccines for children.
What is the AAP’s advice concerning COVID-19 vaccinations for children?
The AAP states that whether most children should receive a COVID-19 vaccine ought to be determined by their specific risk, considering existing conditions like asthma, obesity, or diabetes, and if they reside with individuals susceptible to severe illness. This risk is elevated for the youngest eligible demographic—those aged 6 to 23 months—leading the AAP to advise that all children in this cohort be vaccinated.
Dr. Sean O’Leary, who chairs the AAP Committee on Infectious Diseases, notes, “For the youngest children, the hospitalization rate parallels that of adults aged 50 to 64 years. It is a significant concern. And this pertains to an ailment preventable by a vaccine, a medical product more extensively researched than any other in our history. Our confidence in the vaccine’s safety is exceptionally high.”
The Department of Health and Human Services (HHS) did not provide a response to TIME’s inquiry for comment.
What accounts for the divergence in recommendations?
Typically, the CDC establishes the immunization schedule, specifying which vaccines individuals should receive and at what ages. The CDC bases its decisions on guidance from its Advisory Committee on Immunization Practices (ACIP). ACIP comprises independent experts who voluntarily examine data, deliberate on their discoveries, and formulate recommendations to assist in guiding the CDC.
However, Kennedy—a long-standing vaccine skeptic who now oversees the CDC as head of HHS—intervened regarding all members of ACIP, accusing them of prioritizing industry interests. Days later, Kennedy replaced them with his chosen individuals, “many of whom hold strong anti-vaccine views,” states O’Leary.
Following the replacement of ACIP, the AAP—which ordinarily collaborates closely with the advisory committee and other liaison entities in establishing vaccination schedules—opted not to participate in ACIP’s initial meeting under the new administration that spring. O’Leary remarks, “We observed from that gathering that ACIP has, in essence, deviated significantly in its operational methods and in the communications from its new members, which largely centers on fostering skepticism about vaccines rather than issuing evidence-based vaccine recommendations.”
Weeks afterward, the AAP and other collaborating groups were requested to cease their involvement in ACIP work groups, according to O’Leary. He states, “We received an email rescinding our invitation.” The stated reason, he notes, was that these organizations constituted “special interest groups,” which O’Leary deems a “flawed interpretation of the regulations. All participating organizations possess expertise, and there are ample justifications for including representation from professional societies.”
Whose recommendations will medical practitioners and pharmacists adhere to?
O’Leary indicates that pediatricians foresee needing to engage in more frequent discussions with families regarding the contradictory vaccine guidance, and that the AAP is offering resources to facilitate these conversations through its website and member emails. He observes, “Politics has permeated the examination room in an unprecedented manner. These conversations will be situational, contingent on the pediatrician’s familiarity with the family, their established relationship, and the extent of candor achievable during the discussion.”
Ultimately, he asserts, pediatricians should convey this message: “Our dedication is to children’s health, and our recommendations are grounded in the foremost scientific evidence.”
Pharmacists are required to adopt a somewhat different stance, as their authority to vaccinate is limited to the CDC’s recommendations, whereas physicians can administer vaccinations beyond strictly approved conditions or populations in what is termed “off-label” use. Given that current CDC recommendations state families should independently decide whether their children receive the vaccine, pharmacists will administer shots if parents desire them, but will not specifically advise individuals to get them. Rick Gates, chief pharmacy officer at Walgreens, states, “Our directive is always to adhere to the recommendations of the CDC or HHS.”
Should families present with inquiries about whether their child ought to receive the COVID-19 vaccination, pharmacists will likely direct them back to their pediatrician or family doctor.
Will insurers provide coverage for pediatric COVID-19 vaccines if the CDC does not endorse them?
The manner in which insurers will react to the divergent recommendations remains uncertain. Dr. David Higgins, an infectious-disease expert at AAP, expresses, “This constitutes a genuine apprehension.” Conventionally, an ACIP recommendation implies that a vaccination will be covered, as all vaccines endorsed by the committee must be reimbursed by insurers under the Affordable Care Act. It is unclear how insurers will interpret families’ individual discretion regarding childhood vaccinations.
The AAP is advocating for insurers to maintain coverage for the COVID-19 vaccine for infants aged six to 23 months, notwithstanding ACIP’s lack of recommendation for all children within this age bracket.
Higgins states, “The AAP is already collaborating with private insurers and policymakers to guarantee coverage for our evidence-based recommendations, and we will persist in advocating for vaccine accessibility for every child in every community.”