In its first meeting since June, the CDC’s Advisory Committee on Immunization Practices voted in favor of several key recommendations that would alter federal vaccine guidelines if adopted by the CDC.

Five takeaways:

1. Day one. On Sept. 18, ACIP voted 8-3, with one member abstaining, to not recommend the quadrivalent MMRV vaccine to children younger than 4 years old.

At present, 85% of U.S. children receive separate vaccines, though the combination vaccine is available for parents who wish to give their child a single shot, according to NPR. Committee members who voted in favor of the change cited evidence showing a slightly higher risk of fever-related seizures in children ages 12 to 23 months who receive the MMRV shot. ACIP has previously reviewed this evidence and adjusted its recommendations to allow for parental preferences, according to CIDRAP News.

For MMR and varicella vaccination, the CDC recommends infants receive their first dose between 12 to 15 months of age, and a second dose between ages 4 and 6. The agency also currently recommends clinicians administer MMR and varicella vaccines separately for the first dose.

2. Day two. In a revised second vote the morning of Sept. 19, the committee voted 9-0, with three abstaining, to change the Vaccines for Children resolution for MMRV vaccination — meaning the program will not cover the combined shots.

The committee tabled a vote on delaying the first dose of the hepatitis B vaccine among infants whose mothers test negative for the disease amid confusion and debate about the wording of the recommendation. The panel did unanimously vote in favor of all pregnant women being tested for hepatitis B infection.

For COVID-19 vaccines, the committee unanimously voted to recommend that individuals six months and older engage in shared decision-making with their healthcare provider when deciding whether to get vaccinated, emphasizing the vaccine’s risk-benefit equation for patients younger than 65. The decision contrasts past recommendations from ACIP that all individuals 6 months and older receive COVID-19 vaccines.

After a 6-6 tie concerning whether state and local jurisdictions should require a prescription for COVID-19 vaccines, ACIP Chair Martin Kulldorff, PhD, broke the tie and voted against the recommendation.

In a unanimous decision, the committee recommended clinicians conduct a more comprehensive informed consent process and discuss the risks and benefits of COVID-19 vaccines with patients.

ACIP’s recommendations are pending approval from acting CDC director Jim O’Neill to become official guidance.

3. State actions. In recent months, many states have taken steps to ensure broad access to vaccines, regardless of federal policy.

On Sept. 17, the West Coast Health Alliance — which includes California, Oregon, Washington state and Hawaii — released unified vaccine recommendations for the 2025-26 virus season. State health officials developed the recommendations for flu, COVID-19 and RSV vaccines based on guidelines from medical associations, including the American Academy of Pediatrics, the American College of Obstetricians and Gynecologists and the American Academy of Family Physicians. In addition, California Gov. Gavin Newsom signed a law authorizing the state to base future vaccine guidance on independent medical associations, as opposed to ACIP.

States on the East Coast, including New York, are taking similar action via the formation of the Northeast Public Health Collaborative. On Sept. 18, the group issued its own COVID-19 vaccine recommendations, which differ significantly from federal guidance. The collaborative recommends COVID-19 vaccines for all infants 6 to 23 months, along with all adults 19 and older. All children 2 and older may also be vaccinated, the guidelines say. Last month, the FDA limited approval of updated COVID-19 vaccines to adults 65 and older, along with individuals who have at least one condition that puts them at high risk for severe illness.

4. ACIP’s overhaul. The meeting marks the second time ACIP has convened since HHS Secretary Robert F. Kennedy Jr. overhauled the committee in June, removing all 17 members. He has since named 13 new members to the committee, with the latest appointed Sept. 15. Many members have previously shared anti-vaccine rhetoric or made unfounded claims about vaccines.

5. Lingering questions. Although private insurers have committed to covering vaccines at no cost this year regardless of the ACIP’s guidance, what remains unclear is whether Medicaid — the largest insurance provider for children in the U.S. — will alter its coverage policies to align with the CDC. Historically, CMS has latched its vaccine coverage strategy to the CDC’s recommended schedule. The Children’s Health Insurance Program could also be affected.

If the CDC adopts the ACIP’s recommended changes and CMS follows suit, state Medicaid agencies will be closely watching if and when the federal program announces the change, how comprehensive its guidance will be, and whether it will be up to each state to decide on coverage.

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