CDC Issues New Advice on Covid Vaccines for Children That Contradicted RFK Jr.

Days after Health Secretary Robert F. Kennedy Jr. announced that Covid shots would be removed from the federal immunization schedule for children, the Centers for Disease Control and Prevention issued updated advice that largely countered Mr. Kennedy’s new policy.

The agency kept Covid shots on the schedule for healthy children 6 months to 17 years old, but added a new condition. Children and their caregivers will be able to get the vaccines in consultation with a doctor or provider, which the agency calls “shared decision-making.”

The shots will also remain available under those terms to about 38 million low-income children who rely on the Vaccines for Children program, according to an emailed update from the C.D.C. on Friday.

Mr. Kennedy’s original pronouncement on Tuesday had caused an uproar among pediatricians and public health experts, who pointed out that very young children and pregnant women face high risks of severe illness from the virus. Many also worried that the new policy would prompt insurers and government programs to reduce or drop coverage of the cost of the shots.

The latest changes clarify coverage for healthy children older than 6 months. But they leave those highest-risk groups — pregnant woman and young infants who are covered by immunization during pregnancy — without a formal recommendation.

The quick retreat this week from Mr. Kennedy’s vaccine proposals adds to a long list of Trump administration pledges that have been reversed days later. President Trump’s tariff policies, for example, have been revised repeatedly, and often weakened, after his tougher, initial actions.

Within the Department of Health and Human Services, Mr. Kennedy has also modified or selectively pulled back from his agenda. For example, after presiding over a reduction of 20,000 department employees that has shuttered many programs, he allowed for the return of some whose departures from important roles had drawn criticism from lawmakers and public health experts.

Mr. Kennedy’s efforts to revamp and, in some cases, dismantle standard vaccine protocols represent his long-held views as a vaccine skeptic. He has campaigned against Covid shots for children, and his decision this week to no longer recommend the vaccine for healthy children is aligned with vaccine skeptics who have opposed state mandates for vaccines and clamored for parents to decide which inoculations their children should receive.

In a statement, Andrew Nixon, a spokesman for the Department of Health and Human Services, defended the shifts in policy this week.

“The old Covid-19 vaccine recommendations for healthy children under 18 and for pregnant women have been removed from the C.D.C. vaccine schedule,” Mr. Nixon’s statement said. “The C.D.C. and H.H.S. encourage individuals to talk with their health care provider about any personal medical decision.

“Under the leadership of Secretary Kennedy, H.H.S. is restoring the doctor-patient relationship. If a parent desires their healthy child to be vaccinated, their decision should be based on informed consent through the clinical judgment of their health care provider.”

The policy changes on vaccines did not end uncertainty for pregnant women.

Last week, the Food and Drug Administration cited pregnancy as a high-risk condition that would qualify a woman for a Covid vaccine, which also contradicts the decision by Mr. Kennedy to drop pregnant women from the C.D.C.’s recommendations.

The dropped guidance for pregnant women is troubling to experts who point to research showing that the risk of stillbirth, preterm birth, hospitalization and death rises if pregnant women contract Covid.

Dr. Michelle Fiscus, a pediatrician and chief medical officer with the Association of Immunization Managers, said that she had expected a modified recommendation from the C.D.C. advising pregnant women to get the vaccine if they had an additional medical condition putting them at high risk.

“So that’s concerning,” she said.

On the C.D.C. ‘s website, the section on pregnancy and the Covid vaccine continues to urge pregnant and postpartum women to get the shot. If pregnant, women are “more likely to need hospitalization, intensive care or the use of a ventilator or special equipment to breathe if you do get sick from Covid-19.”

“Severe Covid-19 illness can lead to death,” the agency warns.

Dr. Paul Offit, a pediatrician and vaccine expert at the Children’s Hospital of Philadelphia, said the initial clinical trials for the Covid vaccines did not include pregnant women. However, researchers gathered data on tens of thousands of pregnant women after they got the shot to determine that the vaccines were safe.

When the risks of death and pregnancy loss for unvaccinated women became clear, the C.D.C. issued an “urgent recommendation” that pregnant women get the Covid vaccines. He said the recent limitations on Covid shots, in addition to other policy moves, such as slashing funding for development of a bird flu vaccine, amounted to a “war against vaccines.”

The C.D.C.’s determinations can be influential in setting insurance and public benefit coverage. It remains unclear how private health insurers and Medicaid will approach coverage of the Covid vaccine for pregnant women. A Covid shot costs about $130 out of pocket, which does not include a service fee to the facility or person administering the service. The total bill can exceed $200.

And the policy change on consultations with doctors or providers is likely to create barriers for children hoping to get a vaccine at a retail pharmacy, said Richard Hughes IV, a lawyer with Epstein Becker & Green who has advised vaccine companies. There is little privacy in pharmacies for consultations, and states differ in the scope of services pharmacists are permitted to perform.

“It is problematic,” he said. “It varies a lot by state and can create some issues for sure.”

The recommendation for “shared decision-making” with a health care provider is also likely to give some private insurers reason to withhold coverage, Mr. Hughes said. Insurers prefer clearer language — like they “must” or “shall” cover the vaccines — from the federal government’s experts, he added.

“The way it’s worked, in terms of coverage and access, has been a real challenge,” he said.

The changes continued Mr. Kennedy’s penchant for bypassing the accepted process for deciding vaccine policy. Last week, the F.D.A. said that adults over 65 and those with certain medical conditions could obtain new Covid vaccines in the fall. But the agency did not release a detailed outline of new information about risks and benefits of the product, as had accompanied past decisions.

Typically, the C.D.C. Advisory Committee on Immunization Practices holds a public meeting where experts review data on vaccine safety and on rates of illness, hospitalization and death. The committee members then issue recommendations on who, depending on age groups or medical conditions, should get each vaccine. That committee, scheduled to meet later in June, had no say in the latest policy shifts this week.