The US Centers and Disease Control and Prevention is considering recommending annual Covid-19 shots to those who are older or who have compromised immune function, rather than the current blanket recommendation for everyone 6 months of age and older.
The change would more closely align the US with guidance given in other countries. Unlike countries such as the United Kingdom, Canada and Australia, the US alone recommends an annual Covid-19 vaccine for healthy younger adults and children. The World Health Organization also doesn’t routinely recommend annual Covid-19 vaccines for healthy adults under 65 or healthy children.
On Tuesday, a panel of independent experts that advises the CDC on its vaccine recommendations, called the Advisory Committee on Immunization Practices, weighed the pros and cons of moving the US away from a blanket recommendation that most people get an updated Covid-19 shot every year and toward a more nuanced, risk-based recommendation.
Members of the Covid-19 vaccine work group said they began studying the policy change in November.
Under a risk-based recommendation, the CDC would continue to recommend two doses of Covid-19 vaccines each year for older adults — those over 65 — and to anyone with weakened immune function.
It may also consider recommending annual vaccination for adults and children who are at high risk of Covid-19 disease because they have a higher risk of being exposed to it. Those groups could include people like health-care workers or children in day care.
There was also strong support for a statement in the recommendation to say that anyone who wanted to get a Covid-19 vaccine could still get one, even if they didn’t fit into a higher-risk category.
A risk-based recommendation would be more complicated to communicate to the public and potentially trickier to implement than a universal recommendation, and some members of the full committee said they’d be against it for that reason.
“I guess I’m surprised that we’re considering a risk-based recommendation, which in general, we have not had a lot of success with implementing in the US,” said committee member Dr. Denise Jamieson, dean of the Carver College of Medicine at the University of Iowa.
Jamieson said she also worried that some people could lose insurance coverage for their Covid-19 vaccines if the recommendation was softened for some groups.
It’s also not clear where the committee might land on underlying health conditions and who would be considered at higher risk based on a pre-existing condition, such as diabetes or heart or lung diseases.
An analysis of data based on the CDC’s list of conditions that increase the risk for severe disease from a Covid-19 infection found that 74% of adults have at least one health condition that puts them at risk.
And even though Covid is no longer causing the same kind of punishing waves of illness and death as it once did, it was still the 10th leading cause of death among adults in 2023. From September 2023 through August 2024, it caused roughly 40,000 deaths in the US.
“Covid is still a fairly dangerous disease and very, very common,” said committee member Dr. Jamie Loehr, who runs a family practice clinic in Ithaca, New York.
Loehr said he wondered how feasible it might be to implement a risk-based recommendation and what message it might send to the public.
“Even though I’m in favor of a risk-based recommendation, I still have my hesitations,” he said.
Others worried that exempting healthy adults might make long Covid more common. Studies have shown that vaccination cuts the risk of developing the condition, which affected more than 9 million adults and children in 2023, according to national surveys.
“What I would like to see is modeling around long Covid,” said committee member Dr. Oliver Brooks, the chief medical officer of Watts Healthcare Corp. in Los Angeles. “My primary concern through all of this at this point is long Covid.”
Though there was concern that risk-based recommendations would decrease vaccination, others pointed out there’s no proof that’s true.
“There’s not clear evidence at all that risk-based approaches are less effective,” said committee member Dr. Noel Brewer, a professor of public health at the University of North Carolina. “The data supporting that claim are not really there.”
On the whole, members of the committee who have studied the question most closely said they favored switching to risk-based recommendations.
As of April, more than three-quarters of the working group on the Covid-19 vaccine recommendations for this coming fall and winter favored risk-based recommendations, though they don’t plan to formally vote on the policy change until the next meeting, which is scheduled for June.