Worth a Shot: How ACIP Changes Might Impact Vaccine Access, Coverage

In the latest episode of Worth a Shot, Adam Colborn, JD, vice president of government affairs at the Academy of Managed Care Pharmacy (AMCP), warns that ongoing disruption to the Advisory Committee on Immunization Practices (ACIP) process threatens vaccine access, particularly for low-income children and other vulnerable populations.

Colborn explains that recent changes to ACIP’s charter significantly alter both its mission and structure. The revised charter, he notes, “greatly expands consideration of nonvaccine preventive measures and international schedules, and it also places greater emphasis on identifying gaps or uncertainties in vaccine safety.” It also shifts the qualifications for members toward expertise in “vaccine injury and things like that,” which he cautions could skew perceptions of risk.

“Vaccines are a pretty well-studied type of medicine,” Colborn says, warning that an overemphasis on injury surveillance systems that don’t reliably establish causality “risks overstating the volume and severity of vaccine injury, while downplaying the very well-established benefits of a robust immunization strategy for public health.”

From AMCP’s perspective, Colborn stresses that safety review must remain rigorous and evidence-based but balanced.

“We have to follow the evidence where it leads…Changes that reduce our reliance on scientific expertise or reduce transparency in decision-making…all risk creating confusion for patients and the health care ecosystem,” he says.

The fallout from court rulings and stalled ACIP activity is already being felt in coverage and reimbursement. Because the court decision effectively reverted ACIP recommendations to those in place in January 2025, some newer or updated vaccines are caught in limbo. Colborn is particularly worried about “newly approved vaccines or updated formulations or expanded indications” that have not yet received ACIP recommendations. Since the Affordable Care Act’s preventive services mandate is tied to ACIP, “we may see a lag time…it’ll be a slower decision-making process than previously because we don’t have ACIP putting a stake in the ground.”

Pharmacists, who now provide more than half of all immunizations, are on the front lines of this uncertainty. Colborn believes that, in most cases, “a pharmacist who administers a vaccine consistent with the recommendations and coverage policies that are in effect on the date of service should feel comfortable…submitting the claim through the normal process.”

“The potential for confusion is still significant…it may put more work on pharmacists. But then also patients will…be more confused and then less likely to go get a vaccine because they don’t know what’s recommended for them,” he says.

The risk is especially acute for the Vaccines for Children (VFC) program, which is legally tied to ACIP recommendations.

“I think it’s totally at risk, and I would say it is more at risk than other types of coverage,” Colborn says. VFC administers “almost half of all childhood immunizations,” and disruptions in which vaccines or schedules are recommended could have long-term consequences for low-income children’s health and access to newer vaccines.

Colborn argues that a “stable ACIP process is independent…transparent…and timely and grounded in the totality of the scientific evidence.” He sees AMCP’s role as bringing “the operational perspective of managed care pharmacists, health plans, and frontline pharmacy practice” to policymakers, helping them understand “how these recommendations translate into coverage, reimbursement, and patient access,” and flagging disruptions “before they prevent a patient from receiving a vaccine.”