2026-2027 Respiratory Vaccine Guidance for Pharmacists

As pharmacists brace for the 2026–2027 respiratory virus season, evolving federal guidance and new products are adding complexity to an already busy fall.

In a recent episode of Elevating Practice: The Future of Pharmacy, Kelly Goode, PharmD, BCPS, FAPhA, FCCP, a professor in the Department of Pharmacotherapy and Outcomes Science, School of Pharmacy, Virginia Commonwealth University, laid out how community pharmacists can navigate this landscape.

Goode explained that vaccine policy continues to be anchored by the Advisory Committee on Immunization Practices (ACIP), which issues recommendations for the CDC, with the current child/adolescent and adult schedules dated July 2025. Around those schedules, pharmacists should turn to specialty societies for nuance.

“If I’m looking for pediatric vaccines, I would look at the American Academy of Pediatrics. If I’m looking for adult vaccines, I’m going to go to the AAFP or American Academy of Family Physicians,” she said. “If I am looking for immunocompromised individuals, I’m going to go to the Infectious Disease Society of America, and if I am looking for pregnancy or postpartum breastfeeding, I’m going to go to ACOG.”

Although most guidance is aligned, recent policy shifts have reshaped COVID-19 recommendations. A May 2025 Health and Human Services directive removed the routine recommendation for COVID-19 vaccination in pregnancy and moved childhood COVID-19 vaccination to shared clinical decision-making, changes now reflected in the July 2025 ACIP schedule. A new monoclonal antibody, clezrivimab, has emerged but has not yet been incorporated into ACIP recommendations.

For the 2026–2027 influenza season, pharmacists can expect a trivalent vaccine with a completely updated strain composition.

“We’re going to have all of our…trivalents. We have two A’s and a B, and all the strains that are in that trivalent vaccine have changed,” Goode said. “You can tell patients, ‘yes, it’s a different vaccine.’”

She pointed to several additional developments, including the extension of the recombinant vaccine Flublok down to age 9 years and FDA approval of Influzivia, a new mRNA flu vaccine from Moderna for adults 50 and older. However, major organizations have not yet issued detailed recommendations on how to use the new product in practice.

On COVID-19, Goode noted that regulators have already selected the XFG lineage as the strain for the 2026–2027 COVID-19 vaccine, and FDA has instructed manufacturers to use it, even as product-specific approvals have yet to be finalized. On the ground, she warned, COVID-19 activity is again trending upward.

“I’m seeing COVID’s on the rise. So it’s rearing up across the country,” she said. “Having a vaccine will be very important because that’s one of our best protections for illness and severe illness.”

Respiratory syncytial virus (RSV) continues to be a focus for adult and maternal immunization. Adults 75 and older should receive 1 RSV vaccine, and those 50 to 74 years with qualifying chronic conditions or in care facilities may also be eligible. Pregnant patients should receive a single RSV vaccine between 32 and 36 weeks’ gestation in 1 pregnancy. In subsequent pregnancies, protection shifts to monoclonal antibodies for the infant.

“Everybody should only have 1 RSV vaccine,” Goode emphasized, adding that pharmacists should work with state or territorial health departments to account for local RSV season timing.

Goode added the consistency of the pharmacy team’s message can be decisive. “That recommendation from the pharmacist is one of the best ways to get somebody to consider a flu vaccine,” she said. Rather than asking if patients want the shot, she recommends a presumptive, confident approach.

Ultimately, she urged pharmacists to know their state scope of practice, follow professional society guidance, and lean on evidence-based medicine as they guide patients through another complex season.