Should you give your baby a COVID-19 shot? The answer isn’t as straightforward or as much of a consensus as it used to be: In an unusual move, the American Academy of Pediatrics (AAP) is recommending a different approach to childhood vaccination than the U.S. Centers for Disease Control and Prevention (CDC).
Both groups agree that families should make individual decisions in consultation with their doctors about whether kids should be vaccinated. But the AAP has a stricter stance for the youngest eligible children in the U.S., recommending that all of them get COVID-19 shots.
The CDC stopped recommending COVID-19 vaccines for healthy children older than six months following guidance from the Secretary of the Department of Health and Human Services, Robert F. Kennedy Jr., in May. The CDC does, however, recommend the shot for children who are moderately or severely immunocompromised.
A day after the AAP released its recommendations, Kennedy fired back at the organization on social media, accusing them of allowing pharmaceutical-company donors to guide their recommendations. AAP maintains that its recommendations are based on science.
Here’s what to know about the clashing advice regarding COVID-19 vaccines for kids.
What does the AAP recommend in terms of COVID-19 shots for children?
Whether most children should get a COVID-19 vaccine should be based on their particular risk, the AAP says—taking into account their underlying conditions, such as asthma, obesity, or diabetes, as well as whether they live in a household with people at high risk for developing severe disease. That risk is higher for the youngest eligible age group—ages 6 months to 23 months—which is why the AAP recommends that all kids in this age group get vaccinated.
“For the youngest kids, the hospitalization rate is similar to that for adults 50 to 64 years old,” says Dr. Sean O’Leary, chair of the AAP Committee on Infectious Diseases. “It’s not nothing. And that’s for something that can be prevented by a vaccine, which has been better studied than any medical product in our history. We have a very strong level of confidence in the safety of the vaccine.”
HHS did not respond to TIME’s request for comment.
Why are the recommendations different?
Generally, the CDC sets the schedule for which vaccines people should get and at which ages. The CDC makes its decision based on advice from its Advisory Committee on Immunization Practices (ACIP). ACIP is made up of independent experts who volunteer to review data, discuss their findings, and make recommendations to help guide the CDC.
But Kennedy—a longtime vaccine-skeptic who now oversees the CDC as head of HHS—fired all members of ACIP in June, accusing them of following industry interests. Kennedy replaced them days later with people he had selected, “many of them with strong anti-vaccine views,” says O’Leary.
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After ACIP was replaced, AAP—which typically works closely with the advisory committee and other liaison groups in setting vaccination schedules—decided not to attend ACIP’s first meeting under the new administration in the spring. “We saw from that meeting that ACIP has gone off the rails, essentially, in terms of the way they are operating and the messaging from the new members, which is very much around sowing distrust about vaccines and not making evidence-based vaccine recommendations,” says O’Leary.
Weeks later, the AAP and other liaison groups were asked to discontinue their participation in ACIP work groups, O’Leary says. “We received an email un-inviting us,” he says. The reason provided, he says, was that the organizations represented “special interest groups,” which O’Leary says is a “poor interpretation of the rules. All of the organizations at the table have expertise, and there are a lot of reasons to have representation from professional societies.”
Which advice will doctors and pharmacists follow?
O’Leary says pediatricians are anticipating having to have more conversations with families about the conflicting vaccine advice, and that the AAP is providing guidance to help inform those discussions on its website and via emails to its members. “Politics has entered the exam room in a way that it never has before,” he says. “These discussions will be contextual, depending on how well the pediatrician knows the family, what relationship they have, and how frank they can be with them in the discussion.”
Ultimately, he says, the message from pediatricians should be this: “We are committed to the health of children, and our recommendations are based on the best available science.”
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Pharmacists must take a slightly different approach, since they are only allowed to vaccinate according to the CDC’s recommendations, while doctors can vaccinate outside of strictly approved conditions or populations in so-called “off-label” use. Since current CDC recommendations say that families should make their own decisions about whether their children receive the shot, pharmacists will vaccinate kids if parents want them to have the shots, but won’t specifically recommend that people get them. “Our guidance is to always follow what the CDC or HHS recommends,” says Rick Gates, chief pharmacy officer at Walgreens.
If families come in with questions about whether their child should get the COVID-19 shot, pharmacists will probably refer them back to their pediatrician or family physician.
Will insurance cover COVID-19 vaccines for kids if the CDC doesn’t recommend them?
It’s still not clear how insurers will respond to the differing recommendations. “This is a real concern,” says Dr. David Higgins, an infectious-disease expert at AAP. Traditionally, a recommendation from ACIP means that a shot will be covered, since any vaccines recommended by the committee have to be reimbursed by insurers under the Affordable Care Act. It’s not clear how insurers will interpret the individual choice of families when it comes to vaccinating children.
The AAP is urging insurers to continue covering the COVID-19 vaccine for infants six to 23 months, despite the fact that ACIP does not recommend the vaccine for all kids in this age group.
“The AAP is already engaging with private insurers and policymakers to ensure our evidence-based recommendations are covered,” Higgins says, “and we will continue to advocate to make vaccines accessible to every child in every community.”
