CDC revises recommendation for COVID vaccines in kids

The Centers for Disease Control and Prevention (CDC) yesterday updated its childhood immunization schedule with a revised recommendation on COVID-19 vaccines for healthy children.

The changes partly reflect a new position on COVID vaccine recommendations for healthy children announced earlier in the week by Department of Health and Human Services Secretary Robert F. Kennedy Jr., though they do not go as far as Kennedy had suggested.

Clinical judgment, personal preference

The CDC childhood immunization schedule now says that healthy children ages 6 months to 17 years, when the parent expresses a desire for their child to vaccinated, “may receive COVID-19 vaccination, informed by the clinical judgement of a healthcare provider and personal preference and circumstances.” Previously, the agency had recommended COVID-19 vaccines for healthy children ages 6 months and older, based on the recommendation of the CDC’s Advisory Committee on Immunization Practices. 

In a May 27 video statement, Kennedy, accompanied by Food and Drug Administration Commissioner Martin Makary, MD, MPH, and National Institutes of Health Director Jay Bhattacharya, MD, PhD, announced that COVID vaccines for healthy children and healthy pregnant women had been removed from the CDC recommended immunization schedule. 

“There’s no evidence healthy kids need it today, and most countries have stopped recommending it for children,” Makary said. 

While the revisions to the childhood immunization schedule indicate COVID-19 vaccination is still an option for healthy children, the CDC now emphasizes “shared clinical decision-making” between parents and providers.

“Unlike routine, catch-up, and risk-based recommendations, shared clinical decision-making vaccinations are individually based and informed by a decision process between the health care provider and the patient or parent/guardian,” the CDC website says.

Concerns about process, insurance coverage

Kennedy’s announcement that the CDC would no longer recommend COVID vaccines for healthy children and healthy pregnant women has drawn criticism from several medical groups, including the American College of Obstetricians and Gynecologists and the Infectious Diseases Society of America (IDSA).

“This decision bypassed longstanding processes through which the Advisory Committee on Immunization Practices of the CDC — an external body of highly vetted experts — conducts a robust review of scientific evidence in open, public meetings to make vaccine recommendations for people of all ages,” IDSA President Tina Tan, MD, said in a statement following the Kennedy announcement. 

“It is concerning that such a significant policy change was made unilaterally outside an open, evidence-based process with no regard for the negative impact this will have on millions of Americans.” 

Tan and others have raised concerns that removal of the recommendation could mean that health insurers will no longer cover COVID-19 vaccines for healthy children and healthy pregnant women who want them. But according to the CDC, shared clinical decision-making recommendations on the immunization schedule are required to be covered by private insurers under the Affordable Care Act.

The CDC is still recommending COVID vaccination for children ages 6 months to 17 years who are moderately or severely immunocompromised.