RFK Jr. dropping COVID vaccine guidance for kids, pregnant women

Health and Human Services Secretary Robert F. Kennedy Jr. said Tuesday that he would remove the Centers for Disease Control and Prevention's recommendation for children and healthy pregnant women to get vaccinated for COVID-19.

"I couldn't be more pleased to announce that, as of today, the COVID vaccine for healthy children and healthy pregnant women has been removed from the CDC's recommended immunization schedule," Kennedy said in a video attached to his post.

However, as of Tuesday morning, the CDC had so far not updated the immunization schedule to reflect the removal announced by Kennedy.

Kennedy's move, announced Tuesday on X, appears to effectively shortcut a process set up by the agency's outside advisers to discuss and make changes to the CDC's influential vaccination guidance, which is directly tied to what insurers are required to cover and liability protections.

Those advisers had already been weighing whether and how to narrow the agency's COVID-19 vaccine recommendations to only older adults and other people with an underlying condition that put them at risk of more severe illness from COVID-19.

Kennedy's announcement also goes further than the advisory panel, which had been weighing including pregnant women as among those who would remain eligible for COVID-19 vaccine recommendations, given their increased risk of severe disease and the fact that it could also help provide some protection to their newborns.

It is not clear why Kennedy chose to announce the decision without waiting for the Advisory Committee on Immunization Practices to complete its deliberations. The panel had been expected to vote on the issue at the routinely scheduled June meeting hosted by the agency.

"With the COVID-19 pandemic behind us, it is time to move forward. HHS and the CDC remain committed to gold standard science and to ensuring the health and well-being of all Americans — especially our nation's children — using common sense," Vianca N. Rodriguez Feliciano, a spokesperson for the Department of Health and Human Services, said in an email.

Kennedy has also stalled other overdue recommendations from the panel for respiratory syncytial virus, or RSV, vaccines and meningococcal vaccines.

The committee had voted on updated recommendations for those vaccines in April. Usually it is up to the CDC director to approve the recommendations. But it has been up to Kennedy to decide whether to adopt the new guidance, since the Trump administration has not appointed an acting CDC director to replace Susan Monarez, who stepped aside from that role while she goes through the nomination process for CDC director.

Only one recommendation from the April meeting, an update to restrict use of a Chikungunya vaccine linked to potentially severe side effects, has been greenlighted by Kennedy.

HHS has not responded to requests for comment on why the other recommendations have been delayed.

While COVID-19 vaccines still remain available for now, experts say that access to the shots for children and during pregnancy could get harder once Kennedy's changes are official.

The CDC's immunization guidance is closely watched by health experts because it serves as the basis for legal requirements for which vaccines health insurance plans are required to cover with no cost-sharing.

Removing the CDC's recommendations for children and pregnant women to be routinely vaccinated could mean those patients might have to start paying out of pocket for some or all of the cost of COVID-19 shots.

The CDC's vaccine recommendations also govern access to the shots through the federal Vaccines for Children program, which provides COVID-19 vaccines to uninsured children. Guidance from the Centers for Medicare and Medicaid Services, for Medicaid and the Children's Health Insurance Program, requiring coverage of vaccinations to children and during pregnancy, is also tied to the CDC's recommendations.

According to the CDC's price lists, the private sector price tag for COVID-19 vaccines starts at $57.50 per dose in children and $136.75 in adults.

Another way that removing the recommendation could narrow availability of the shots is through the liability protections that Administration for Strategic Preparedness and Response issued during the COVID-19 pandemic, expanding access to the shots for children in places like pharmacies.

Spokespeople for CDC, ASPR and CMS did not immediately respond to requests for comment.

"That would esssentially close the door to pharmacists administering COVID-19 vaccines to children and pregnant women at pharmacies. And as we know, throughout the pandemic and over the last few years, the pharmacy has been the primary location where many have been receiving their vaccines," said Richard Dang, assistant professor of clinical pharmacy at the University of Southern California.

Dang represents the American Pharmacists Association on the COVID-19 work group to CDC's vaccine advisers. He previously led the city COVID-19 vaccination program in Los Angeles.

While Dang said there are other pathways for states to enable pharmacists to continue giving COVID-19 vaccines to children and pregnant patients, he warned those were challenging to implement and unlikely to resolve issues with insurance coverage of the shots caused by the change.

"Even if a pharmacy were allowed to administer vaccine off-label through a protocol or collaborative practice agreement, the individual patient would likely have to pay cash for it," Dang said.

The move also puts Kennedy at odds with his new officials at the Food and Drug Administration, who recently said pregnancy was among the underlying conditions that warranted continued eligibility for COVID-19 vaccine approvals.

"This one preventive strategy that is cost-effective, that can be readily available when the ACIP provides a universal recommendation, limits barriers to access. It is a really important mechanism to protect our moms and babies,'" said Dr. Naima Joseph, assistant professor at Boston University.

Like Dang, Joseph is also a member of the COVID-19 work group to the CDC's vaccine advisers. Joseph represents the American College of Obstetricians and Gynecologists.

A statement released by the OB-GYN organization Tuesday voiced frustration with Kennedy's move, warning that COVID infections during pregnancy "can be catastrophic" for families and that "the science has not changed."

Joseph said data still shows that pregnant people have an increased risk of severe disease from COVID-19 and are more likely to be hospitalized. She also said newborns have no other way to get protection from the virus, outside of the mother's vaccination.

"Infants are the second leading group of our population being hospitalized. And when we look into those risks, it's really that they're born to moms who haven't received an updated COVID-19 vaccine," said Joseph.

A spokesperson for HHS did not respond to a request for comment when asked why Kennedy was excluding pregnant moms from getting COVID-19 vaccines.