Vaccine recommendations in the United States are in limbo, access to some shots is suffering, and experts say the uncertainty could last for years after a series of major blows to immunization policy under the Trump administration.
Robert F Kennedy Jr, the secretary of the Department of Health and Human Services, has overhauled vaccination policy. He cut childhood immunization recommendations by a third and replaced the experts on the Advisory Committee on Immunization Practices (ACIP) with handpicked allies. A judge's order has since halted those changes, finding they were not carried out correctly. Kennedy has not nominated any new committee members, so no fresh recommendations are emerging even as new vaccines win approval.
The effects are already reaching patients. Ron Kroening, 63, has asthma and bad allergies this time of year, and his doctor suggested Moderna's new mRNA flu vaccine, which the Food and Drug Administration approved in August for people 50 and older. Trials suggest it offers stronger protection than traditional flu shots. Kroening had to search for the one pharmacy in his area that stocked it, then was charged a $40 co-pay. His insurer told him the shot was not covered because it is not listed as an ACIP vaccine. A retired public health employee who once worked on immunizations for Oklahoma, he said any barrier to vaccination keeps people from getting shots.
Insurers normally have a year or more to add coverage for a new vaccine, so an early co-pay is not unusual. What is different now is that nobody can say when full coverage will begin. Insurers typically have a year from an ACIP recommendation to cover a vaccine by the next plan year, usually starting in January. A December 2026 recommendation would require coverage by January 2028, while one in January 2027 would push that to January 2029. Lindsay Wiley, a law professor at UCLA, said the legal requirement does not take effect quickly. She called a recommendation next year the best case for the new flu shot, but said there is no reason to expect one.
Covid vaccines are the lone exception, since Congress amended the Affordable Care Act to require coverage within 15 days of an ACIP recommendation. Elsewhere the gap has other consequences. Some states bar pharmacists from giving vaccines without an ACIP recommendation. Decisions the committee made before it was disbanded were also halted, including a September 2025 recommendation on new RSV shots, though insurers appear to be covering them anyway. A now-voided vote to end the universal hepatitis B birth dose is influencing possible state laws. Delays have also been reported in Medicare coverage of the new flu shots for seniors, even though the law requires it without a recommendation.
The government has appealed the part of the ruling that disbanded the committee, but experts say nothing prevents Kennedy from following the correct process to appoint new members. Aaron Siri, who has served as Kennedy's lawyer, wrote on Monday that the White House and the Department of Justice are making no serious attempt to revive the committee. Dorit Reiss, a vaccines expert at UC Law San Francisco, agreed that the federal government is choosing not to install a new ACIP.
Reiss said an empty committee may suit Kennedy, whose appointees did not move as quickly as he wanted to change the schedule. Bypassing ACIP, and delaying its reconstitution, could let him make his own recommendations. She also warned that the committee's future is shaky even after the court case ends, because trust in its independence has been aggressively undermined. Restoring it, she said, may require a statute giving it protection.
Kroening's insurer belongs to the industry group AHIP, which has vowed to keep covering all shots recommended as of September 2025, and insurers can choose to cover vaccines before they must. He said he would still pick the new vaccine, and is glad he paid, but is unhappy that insurance did not cover it. "It's a mess right now, what they're doing with our vaccines," he said.