Doctors' Groups Bypass CDC, Issue Their Own Fall Vaccine Guidance for Flu, COVID and RSV

Four of the country's largest medical societies issued their own recommendations Wednesday for who should get flu, COVID-19 and RSV vaccines this fall, stepping into a gap left after the Centers for Disease Control and Prevention did not issue its usual seasonal guidance. Physician groups involved in the effort described it as an unprecedented arrangement in which outside medical societies, rather than the CDC, are setting the country's baseline vaccination advice heading into the respiratory virus season.

The American Academy of Family Physicians, the American Academy of Pediatrics, the American College of Obstetricians and Gynecologists and the Infectious Diseases Society of America released coordinated guidance built on an independent scientific review rather than on any CDC document. The American Academy of Family Physicians said in a statement that annual flu vaccination remains appropriate for everyone 6 months and older without a medical contraindication, that adults 19 and older should get an updated COVID-19 vaccine, and that a single RSV dose is recommended for adults 75 and older and for those 50 to 74 with conditions that raise their risk.

A federal vacuum, filled by four societies

In a typical year, the CDC and its Advisory Committee on Immunization Practices set the schedule each August or September, insurers align coverage to it, and pediatricians' offices and pharmacies follow. This year the agency did not issue updated recommendations for RSV or COVID-19 vaccination before the fall season began, and when it revised its flu guidance this week, the update simply carried forward the prior year's advice without addressing a new mRNA flu vaccine the Food and Drug Administration approved for older adults last month.

The gap follows more than a year of upheaval at ACIP, the CDC panel that has advised on vaccine policy since 1964. Health and Human Services Secretary Robert F. Kennedy Jr., a longtime vaccine skeptic, removed the committee's sitting members in 2025 and replaced them with appointees who have since narrowed several existing recommendations. Physician groups said the resulting uncertainty, not a change in the underlying evidence, is what forced them to act.

To ground the guidance in evidence rather than opinion, the American Medical Association and the Vaccine Integrity Project completed an independent review of the season's data, an effort based at the University of Minnesota's Center for Infectious Disease Research and Policy. Reviewers screened published research using prospectively registered protocols and identified 299 eligible studies — 69 on influenza, 155 on COVID-19 and 75 on RSV — most published between August 2025 and June 2026. The American Medical Association said the review found no new safety concerns for any of the three vaccines and concluded that immunization continues to provide meaningful protection against hospitalization, severe illness and death.

"Unfortunately today, the federal government is not fulfilling that responsibility in the way that it historically has," said Dr. Bruce Gellin, board chair of the Vaccine Integrity Project and a professor of medicine at Georgetown University, adding that "we cannot allow the breakdown of a federal process to create a vacuum in evidence-based vaccine guidance."

What the new guidance recommends

The review's effectiveness figures, cited by the societies to justify their advice, varied by virus and age group. For influenza, vaccination was associated with 31 to 43 percent protection against hospitalization in older adults and 80 percent effectiveness against laboratory-confirmed flu deaths in children. For updated COVID-19 vaccines, the review found 53 percent effectiveness against hospitalization in adults 65 and older, a 76 percent reduction in emergency-department visits among children 9 months to 4 years old, and 58 percent effectiveness against urgent-care visits among pregnant women. RSV immunization showed 69 to 83 percent effectiveness against hospitalization in adults 60 and older, while maternal vaccination was 51 to 70 percent effective at preventing infant hospitalization and the monoclonal antibody nirsevimab cut emergency-department visits by 86 to 97 percent among infants who received it.

On RSV specifically, the American College of Obstetricians and Gynecologists now recommends that pregnant patients between 32 and 36 weeks of gestation receive the Abrysvo vaccine any time between September 1 and March 1, extending a window that previously closed January 31. The group cited recent seasons that peaked later than expected, including one that remained active into May, as the reason for lengthening the recommended period. Infants younger than 8 months whose mothers were not vaccinated, along with some infants age 8 to 19 months in high-risk groups, are advised to receive the monoclonal antibody nirsevimab or clesrovimab instead.

For COVID-19, the pediatric guidance goes further than the CDC's current posture, which tells parents of children under 18 to consult a doctor rather than making a blanket recommendation. The American Academy of Pediatrics instead recommends that infants and children 6 through 23 months without contraindications receive the updated vaccine, and that children and adolescents 2 through 18 at increased risk get a single dose regardless of prior vaccination status. The full reasoning was published as a policy statement in the journal Pediatrics, backed by an accompanying technical report reviewing the underlying evidence.

Who is affected, and whether insurance will pay

The guidance touches nearly every American household with a pediatrician, an obstetrician or an aging parent: infants and toddlers, pregnant patients, adults over 50 with chronic conditions, and anyone over 65. Family physicians said the most immediate practical worry among patients has been whether insurers would still cover a shot recommended by medical societies rather than by the federal panel that has traditionally triggered no-cost coverage under the Affordable Care Act.

Dr. Sarah Nosal, president of the American Academy of Family Physicians, said insurers have indicated they intend to continue covering the vaccines under the new guidance. "We've partnered with other major medical organizations and the Vaccine Integrity Project to make sure that we have the most up-to-date and accurate vaccine recommendations," Nosal said, describing the coordination among the four societies as an effort to give both clinicians and patients a single, consistent source of advice heading into respiratory virus season.

Pharmacists, who administer a large share of adult flu and COVID-19 vaccinations, are among those watching most closely, since pharmacist vaccination authority in many states is tied to nationally recognized recommendations rather than to ACIP votes specifically. Physicians' offices, meanwhile, said they expect patients to arrive this fall with more questions than usual about which shots still apply to them, a dynamic described in early coverage of the announcement as a break from the single, federally anchored message patients have generally received in past years.

What happens next

The societies said they intend to keep issuing consensus updates through the season rather than treating Wednesday's release as a one-time substitute for federal guidance. The Vaccine Integrity Project's review is designed to be revisited as new studies are published, and the American Academy of Pediatrics said its formal policy statements will be incorporated into the Red Book, the reference used across pediatric practice, ahead of the next scheduled revision.

Whether the CDC issues its own updated RSV and COVID-19 recommendations later this fall remains unclear; the agency has not announced a timeline. For now, patients seeking guidance on the shots are being directed to their own physicians' offices rather than to a single federal source, a shift physician groups acknowledged is unusual but said was necessary to avoid a lapse in protection as flu, COVID-19 and RSV activity begins to rise heading into winter.