Q&A: CDC Alters COVID-19 Recommendations, Leading to Confusion on Pediatric Vaccine Schedules

The landscape of childhood immunization in the United States is facing unprecedented upheaval as trusted authorities diverge on COVID-19 vaccine recommendations. For years, the American Academy of Pediatrics (AAP) and the CDC have worked closely to present unified guidance for parents, providers, and policymakers. That harmony was disrupted earlier this year when the Department of Health and Human Services (HHS) announced it would no longer recommend COVID-19 vaccines for healthy children and pregnant patients—a decision swiftly reflected in CDC guidance, but not in the AAP’s updated immunization schedule in August 2025.

Health care professionals must interpret and communicate these evolving recommendations to concerned families. In this interview, Laura Knockel, PharmD, BCACP, clinical associate professor at the University of Iowa College of Pharmacy, discusses her mixed feelings about the split, the confusion it has created for providers and parents, and the heightened responsibility now placed on pharmacists and other frontline health care workers.

Childhood immunization guidance in the US faces confusion as the AAP and CDC diverge on COVID-19 vaccine recommendations, impacting parents and providers. | Image Credit: zefirchik06 - stock.adobe.com

Drug Topics®: AAP diverged from the CDC's recommended vaccination schedule for this upcoming respiratory season. What is your initial reaction to this unprecedented split between two major public health organizations?

Laura Knockel, PharmD, BCACP: I had mixed feelings when I first heard about it. I hate that it's come to this, and I'm saddened. I'm not surprised, and I'm glad that there's another organization stepping up and taking the place and providing those recommendations. I think this is what we were all fearing when the administration nominated a vaccine skeptic for the head of Health and Human Services (HHS). The American Academy of Pediatrics (AAP) is a very trusted organization. They've been doing these recommendations well before ACIP [Advisory Committee on Immunization Practices] was even created. There's been slight differences every now and then between their schedules over the years until the late 90s, when they really worked on purposely doing a harmonized immunization schedule. So it's frustrating to see that relationship is changing, but I understand why it has to change, and so again, I'm just really glad we have these professional organizations that are stepping up and providing those evidence-based recommendations, but the split is going to lead to confusion over what recommendations to follow, and I have a fear that patients will become frustrated and just decide, "I'm just not going to get vaccinated."

Drug Topics: What are the 2 separate recommendations, and what is the significance of them differing?

Knockel: The difference with the most impact is with COVID-19. So going back to May, the Health and Human Services Secretary, [Robert F. Kennedy Jr.], announced that COVID-19 vaccines would no longer be recommended for healthy children and pregnant patients. The CDC then updated their recommendations without ACIP voting, I may add, to use shared clinical decision-making for healthy children and then for pregnancy. They have no guidance or not applicable. So then in August, when the American Academy of Pediatrics released an updated childhood and adolescent immunization schedule, they do recommend the COVID-19 vaccine for all children ages 6 through 23 months. Then for children aged 2 through 18 years old, AAP recommends the vaccine for patients at high risk of severe COVID-19 so like patients with asthma, congenital heart disease, diabetes, residents of long-term care facilities or other congregate settings like group homes, residential treatment facilities, patients who have never been vaccinated against COVID-19, and patients whose household contacts are at high risk for severe COVID-19. So on top of that, they also recommend the vaccine be available for that same age group, 2 through 18 years, who do not fall in those groups but whose parent or guardian desires them to have protection from the vaccine. So really, anyone can get it as far as that age group goes. So these differences are very significant, and which set of recommendations are we supposed to follow? What will providers follow? What will insurances do? What group will states use to update their vaccine requirements for school-aged children? There's a lot of unanswered questions, and hopefully we'll be getting more guidance soon.

Drug Topics: How does having 2 different sets of recommendations—one from the CDC and one from the AAP—complicate the pharmacist's role in providing immunization services, especially with back-to-school season approaching?

Knockel: I think it makes the pharmacist's role even more crucial when we're providing immunization services. Parents and caregivers, they may have confusion about which vaccines their child should receive. So staying up to date is really important, and staying up to date on what the evidence tells us that the COVID-19 vaccine is safe and effective for everyone, including children. In fact, infants and children younger than 2 years old are at the highest risk for severe COVID-19, and so we need to make sure they're protected. So even if your pharmacy doesn't administer immunizations for children, you still play a part in recommending that that child receive the appropriate vaccine wherever they are able to receive it.

READ MORE: COVID-19 Resource Center

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