Covid vaccines’ inclusion on the schedules don’t constitute mandates. The CDC’s independent vaccine advisers voted 15-0 Thursday to add most Covid-19 vaccines offered in the U.S. to the childhood, adolescent and adult immunization schedules.
The immunization schedules, which are updated every fall before going into effect the following year, consolidate all of the CDC’s vaccine recommendations in one document for states that use them as guidance for school entry requirements and busy physicians. The additions formalize recommendations the CDC has already made on Covid vaccination in individuals ages 6 months and older for shots that the FDA has approved or has authorized for emergency use.
Covid vaccines’ inclusion on the schedules don’t constitute mandates, particularly for schoolchildren, which are the purview of states, localities or jurisdictions, depending on local laws. Still, the committee’s vote sparked controversy and debate on social media about what the additions mean for vaccine requirements after Fox News’ Tucker Carlson asserted Tuesday that the CDC would trigger mandates for students.
“This doesn’t represent new recommendations. This represents sort of a summary of existing recommendations,” said advisory panel member Matthew Daley, a senior investigator at the Institute for Health Research at Kaiser Permanente Colorado. “But I will acknowledge … there is symbolism in adding Covid-19 to the childhood immunization schedule, and that symbolism is that we view this as routine and that we view this as Covid is here to stay.”
The FDA has approved two messenger-RNA vaccines targeting Covid: The Pfizer-BioNTech primary series vaccine for people 12 and older and the Moderna primary series for adults 18 and older. They’re each authorized for emergency use for children as young as 6 months, and all booster doses — including new formulations designed to target the original coronavirus strain and two Omicron subvariants — are authorized for emergency use.
The agency also has authorized a two-dose primary series of a protein-based vaccine by Novavax for emergency use in individuals 12 and older, as well as one booster dose in a limited population of adults.
Vaccine law experts acknowledge adding Covid vaccines to the immunization schedule could influence states that are inclined to require them for school entry to do so, and many states use the schedules as guidance for requirements. But the CDC panel’s recommendations do not trigger mandates, and 21 states have passed laws prohibiting Covid vaccine mandates for students.
Nirav Shah, director of Maine’s Center for Disease Control and Prevention and an advisory committee member, noted there are vaccines included on the schedule now, such as seasonal flu shots, that many jurisdictions don’t require for children to attend school.
“Local control matters, and we honor that the decision around school entrance for vaccines rests where it did before, which is at the state level, the county level and at the municipal level, if it exists at all,” Shah said. “They are the arbiters of what vaccines are required, if any, for school entry. This discussion does not change that.”
According to the National Academy for State Health Policy, 21 states have instituted bans against Covid vaccine mandates for students. Washington, D.C., has required students eligible for fully approved Covid vaccines to be immunized by 2023, and California has a similar requirement that won’t kick in before July 2023.
Under the Affordable Care Act, the vaccines’ inclusion on the routine immunization schedule also requires most health care plans to cover their administration with no cost-sharing to patients. While Covid shots are still free for all who want them and are eligible, the federal government has signaled it’ll transition coverage for them to the private market early next year as pandemic response funding dries up.
The committee on Wednesday also unanimously voted to add Covid-19 vaccines to the federal Vaccines for Children program. That move allows the shots to be provided for free to children of families who may not otherwise be able to afford them, such as those who are eligible for Medicaid, un- or underinsured and American Indian or Alaska Native.
The updated immunization schedules note that injury claims linked to Covid vaccines must continue to be made to the Countermeasures Injury Compensation Program, which was designed to compensate people who receive vaccines and other treatments created or used during pandemics. That program has received thousands of claims linked to Covid vaccines but has yet to pay any, in part because federal officials are waiting on patients to submit detailed documentation to back up their allegations.
Adding Covid vaccines to the routine childhood immunization schedule is the first step in potentially getting the shots covered by the Vaccine Injury Compensation Program, a more established program that allows those alleging vaccine injuries to pursue settlements from the federal government instead of vaccine manufacturers. HHS would have to formally add Covid vaccines to the VICP, and Congress would have to pass legislation imposing excise taxes on Covid vaccine doses to be covered under the program.
Patient advocates, attorneys and drugmakers fear the program could collapse without reforms to the federal court that considers claims and the process by which vaccines are added.