Expert Discusses Flu and COVID-19 Vaccine Guidance

Respiratory virus season is underway, and with multiple professional societies releasing recommendations that sometimes diverge from the CDC schedule, many patients—and even clinicians—are struggling to make sense of vaccine guidance for influenza, COVID-19, and respiratory syncytial virus (RSV).

“It’s very confusing. It’s confusing for pharmacists too,” Kelly Goode, PharmD, BCPS, FAPhA, FCCP, professor in the department of pharmacotherapy and outcomes science at the School of Pharmacy at Virginia Commonwealth University, said in an interview. Goode spoke about what has and has not changed in the latest guidance and how pharmacists can help patients navigate mixed messages.

Goode noted that, despite the noise, influenza recommendations remain consistent across key organizations. The Advisory Committee on Immunization Practices (ACIP) continues to recommend universal influenza vaccination for everyone 6 months and older without contraindications, and the American Academy of Pediatrics (AAP), American College of Obstetricians and Gynecologists (ACOG), American Academy of Family Physicians (AAFP), and Infectious Diseases Society of America (IDSA) all support this stance.

“There are some subtle differences,” she acknowledged, but “AAP, ACOG, AAFP, [and] IDSA are all recommending universal influenza vaccines for people who are 6 months and older who don’t have any contraindication.”

A notable development is the introduction of a new mRNA influenza vaccine approved on August 5, 2026, for adults 50 years and older, with accelerated approval in those 65 and older. Although the CDC schedule has not yet incorporated this product, Goode said the American Academy of Family Physicians has recommended it as an option for patients 65 years and older. Reimbursement may lag, however.

“We do think that that vaccine will be paid for. However, I’m hearing that they’re not able to get it through right now billing for Medicare, so there might be some bumps to getting that vaccine paid for,” she said.

For COVID-19, the CDC’s schedule for adults largely reflects United States Department of Health and Human Services-driven recommendations that the ACIP did not formally evaluate. Adults are still advised to receive vaccination, and those 65 years and older should get a second dose 2 to 6 months after the first, preferably around 6 months. But the schedule is less clear for other groups.

“There is no guidance in pregnancy, so the box is gray,” Goode explained, adding that for children 6 months to 17 years, the CDC calls for shared clinical decision-making. In contrast, ACOG explicitly recommends COVID-19 vaccination in pregnancy, recognizing pregnancy as a risk factor for severe outcomes, and the AAP recommends vaccination for children 6 to 23 months, who have higher hospitalization rates despite often being otherwise healthy.

Updates to RSV recommendations are also reshaping seasonal planning. ACOG extended the window for maternal RSV vaccination to September through March, mirroring shifting circulation patterns since the COVID-19 pandemic. Only Abrysvo is approved for pregnancy, and it must be given between 32 and 36 weeks’ gestation. “So if they’re giving to pregnant individuals, it shouldn’t impact stock or ordering,” Goode said, but pharmacies should be prepared to administer it later in the season.

On the practical side, Goode emphasized that coadministration of flu, COVID-19, and RSV vaccines remains acceptable and often preferable. “It’s business as usual for every patient population, not just our immunocompromised patients,” she said. All 3 can be given at the same visit, with separate syringes and appropriate spacing between injection sites. “If you’ve got somebody there ready to go and wants all three vaccines and they’re indicated for all three vaccines, by all means, let’s get them vaccinated.”

For patients who feel no one “agrees” on the vaccine schedule, Goode recommends beginning with empathy. Pharmacists should acknowledge the confusion, explore specific concerns, and then ask permission to share evidence-based information.

“You can really talk about, say, what you know,” she said. “They’re not vastly different. The evidence still supports recommendations. We still know that vaccines save lives.”