Updated September 19, 2025 at 4:16 PM MDT
A panel of vaccine advisers to the federal government debated several changes to COVID-19 vaccine access in a chaotic meeting Friday, marked by confusion over processes, technical difficulties and passionate disagreement among members and other experts in attendance.
Ultimately, the Advisory Committee on Immunization Practices, or ACIP, backed away from its most controversial proposal that called for states to require those who want a COVID-19 vaccine to get a prescription, but the end result is that the COVID-19 vaccine will be less available than it has been the last few years.
The group, which crafts recommendations on vaccine policy for the Centers for Disease Control and Prevention, voted to recommend vaccination for adults 65 and older and younger people, subject to a process called "shared decision making." Their recommendations would not prohibit anyone over six months from getting the shot, but call for patients to speak with a clinician about the risks and benefits.
"In the prior seasons of COVID, we've had routine vaccine access — you or I could go to our pharmacy or doctor's office and just get our vaccine, it was encouraged as a routine recommendation," says Jen Kates, director of global health and HIV policy at KFF.
Friday's vote essentially says "this is no longer routinely recommended — it's 'shared clinical decision-making,'" says Kates. The details about what that entails and how access will play out are not immediately clear, Kates says, but what is clear is that it's a "more narrow recommendation" than it's been in past years.
And ACIP's recommendation states that for people 64 and younger the conversation should emphasize that benefits are greatest for people with the most risk of serious disease and lowest for people without increased risk.
The advisers also voted that the CDC should add information about the possible risks and uncertainties related to COVID vaccine effectiveness to information sheets about the shots. Many of the risks were speculative or already known to be unfounded.
Heated debate and a tie vote
The gathering underscored the turbulent and highly politicized nature of vaccine policy under Health Secretary Robert F. Kennedy Jr.'s leadership, which is now at odds with positions held by major medical organizations.
The recommendation that a prescription be required for anyone to get a COVID vaccine – which could have been a new hurdle in many places, if states adopted the recommendation – ended in a tie. ACIP chairman Martin Kulldorff voted no, breaking the tie. The motion failed.
But the debate over the proposal got heated. Some on the committee warned it would ultimately lead to fewer people getting shots. Dr. Amy Middleman of the Society for Adolescent Health and Medicine, was among many who spoke up, urging committee members to reject this idea.
"If we start asking for prescriptions for vaccines — which are a primary prevention public health strategy — we are going to overwhelm physicians offices."
Earlier this year, Kennedy fired the existing ACIP panel, installed during the Biden administration, and replaced them with his own handpicked roster, including five members he added this week.
Some of those he chose have a history of being critical of vaccines, as does Kennedy himself — he once called COVID-19 vaccines a "crime against humanity." Kennedy's ACIP was widely expected to curb access to the COVID booster.
Over the course of the meeting, many clinicians in attendance raised concerns about how ACIP had sidelined expert input, elevated questionable or preliminary data, and broken from the established process for developing these recommendations, which influence insurance coverage.
"It's troubling to see the erosion of the committee's integrity," said Dr. Sandra Fryhofer, who spoke on behalf of the American Medical Association on Friday, "We're concerned about how vaccine recommendations are being developed by this new panel, data is being selectively used to justify specific conclusions."
In a break from past precedent, the voting topics for the COVID vaccine were not shared publicly until the end of the meeting, when ACIP member Retsef Levi, an MIT professor of operations management, presented them. Several outside medical groups in attendance had requested that they be shared for the sake of transparency.
Levi lead much of the discussion leading up the votes on COVID-19. In his comments, he emphasized safety concerns about the vaccines.
"I don't think that the public currently believes the narrative of safe and effective," he told the panel.
The meeting was marked by disorganization and confusion, even among the voting members. During the vote on individual decision making, Dr. Cody Meissner, tried to understand what it would mean in practice. "A Vaccine Information Sheet is already required by law for every vaccine — so what will change here is the content of the Vaccine Information Sheet. Is that correct?"
Levi said yes, that would be the change. "We suggest that the content will be changed. The CDC will have to apply their judgment about how to do that exactly, given this suggestion that we are making here."
Confusion and a patchwork of policies for COVID shots
In recent weeks, states and insurance companies have undertaken a flurry of actions to blunt the potential impact of ACIP's decisions in their two-day meeting. For instance, California, Oregon and Washington launched a West Coast Health Alliance and states from Maine to Maryland formed the Northeast Public Health Collaborative to issue their own vaccine recommendations.
America's Health Insurance Plans, the industry group for private insurance companies, issued a statement that COVID-19 vaccines would be covered with no cost-sharing through the end of 2026. There's less clarity about how coverage will work for public health insurance programs like Medicaid, Medicare, the Children's Health Insurance Program, and the Vaccines for Children program given this new recommendation.
Regardless of their insurance coverage, patients trying to get vaccinated in different places are reporting that they're being turned away from pharmacies, including caregivers of those with high risk conditions.
Kates says the patchwork of policies and access depending on where you live is reminiscent of the early days of the COVID-19 vaccine rollout.
"In the early days everybody wanted it and there was very little skepticism about it," she says. "Today the demand is much lower, but for those who want it, they're going to have to do a little extra work — I think that's the bottom line here."
While the CDC generally adopts the recommendations of the panel, the votes are not final until acting CDC director Jim O'Neill signs off on them. He was installed by Kennedy after the senate-confirmed director, Susan Monarez, was ousted in part for refusing to commit to adopting ACIP's recommendations before she'd seen evidence, she testified to the Senate earlier this week.
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