Welcome to our biweekly series in partnership with CIDRAP at the University of Minnesota. 

I (Izzy) have always called this week my limbo week, the stretch that sits uncomfortably between the last “carefree” days of summer and the excitement of getting back into a school year routine. 

U.S. vaccine policy remains in its own sort of limbo, a limbo era, if you will. We paused this series last week to bring you a view from 30,000 feet, so we’re picking back up with a lot to cover: Updated COVID vaccines have been approved and are shipping, four of the country’s largest medical societies issued joint fall recommendations without the Centers for Disease Control and Prevention’s (CDC’s) advisory committee, and the CDC publicly disputed Pennsylvania’s report of two measles deaths and pulled them from the national tally.

For most of our lifetimes, three separate questions had a single answer, and that answer was the CDC. What vaccines are recommended, whether you can walk in and get one, and what’s actually happening with disease in this country were all things you could look up in one place. This fall, those three questions have three different answers, and none of them are the CDC. Recommendations are coming from professional societies. Access depends on your state and your pharmacy chain. Even the disease counts are contested between the federal government and the states reporting them.

As someone who collaborates with a great team to put this piece together for you every two weeks, I’d hoped, probably naively, that we’d be further along on the American Academy of Pediatrics (AAP) v. Kennedy legal front by now. I know these things take time, and I’d rather wait for the right decision than a rushed one, but for the millions of Americans trying to figure out which organizations to believe and which vaccines to get, the longer this drags on, the more confusion it causes. Most of what we’re hearing from readers right now comes from looking in the old place and finding either nothing, or something that conflicts with what their own doctor told them.

So, what actually happened, and what does it mean for getting your family vaccinated this fall?

Let’s discuss…

The PDF version of today’s update is here. Read past installments here and today’s update on the Unbiased Science Substack here.

So Who’s Actually In Charge of Vaccine Recommendations Right Now?

The question is a valid one. Yesterday, joint recommendations were issued by the AAP, American College of Obstetricians and Gynecologists (ACOG), American Academy of Family Physicians (AAFP), and Infectious Diseases Society of America (IDSA) for the upcoming 2026-27 respiratory season. The recommendations were posted to a new American Medical Association (AMA) site called SpreadTheFacts.org, with more detailed scientific reasoning published in their peer-reviewed journal, JAMA. 

This work used to happen in partnership with the CDC’s ACIP, but the collaboration ended in June 2025 when committee membership was wiped, and both committee actions and membership remain on hold while the legality of the moves plays out in court.

In the absence of an existing (and functional) federal backbone, these societies commissioned their own review of current evidence through the University of Minnesota’s Vaccine Integrity Project (part of CIDRAP), working alongside the AMA. Each society published guidelines for their respective patient populations. 

• Flu: Recommended for everyone six months and older, and October is ideal (flu before boo). Adults aged 65 and older should preferentially receive an enhanced vaccine (high-dose, adjuvanted, recombinant, or mRNA). If an enhanced vaccine is not available, the recommendation is to get what’s in front of you without delaying. The same can be said about the October window. Any dose of flu vaccine, even administered after October, is better than none.
• COVID: Adults 19 and older should receive an updated vaccine, with a second dose received six months later for adults aged 65 and older (AAFP). Children aged six through 23 months should receive an updated vaccine, and older children can receive the vaccine based on risk and parental preference (AAP). The vaccine is recommended during pregnancy and lactation in any trimester (ACOG). And finally, immunocompromised patients at least six months of age are recommended to receive both COVID and flu vaccines (IDSA).
• RSV: Adults 75 and older, and higher-risk adults aged 50-74 should get a single dose of the vaccine. For most adults, this is not an annual vaccine. Pregnant women can also receive the vaccine, meaning infants are protected either through maternal vaccination at 32-36 weeks, or through receipt of a monoclonal antibody after they are born.

There is one key change from last year. ACOG extended the window for pregnant women to receive the RSV vaccine (now September 1 through March 1), rather than stopping at the end of January. This is based on observations that RSV seasons have been trending toward beginning later in the respiratory season and running longer, so the updated window reflects those considerations.

These recommendations are broader than the Food and Drug Administration’s (FDA’s) approval criteria, and ultimately the approval is what determines what the manufacturer can market and what a pharmacist is allowed to administer. The recommendations are guidelines for what your clinician should offer you. And ultimately, those guidelines will vary based on where you live, as many states have legally ensured they can rely on vaccine recommendations outside exclusively the ACIP.

Image originally posted by KFF. 

Updated COVID Vaccines Are Here. Can You Get One?

The FDA approved the updated 2026-27 COVID vaccines on August 27 for people aged 65 and older, as well as younger people with a condition that raises their risk of severe illness. FDA officials estimated last year that somewhere between 30% and 60% of Americans have a qualifying condition, and the list is long (asthma, diabetes, obesity, physical inactivity, pregnancy, cancer, immune deficiency, some mental illnesses, and a range of heart and lung conditions). And clinicians can vaccinate off label outside of the FDA approval.

The greatest complication is that most Americans get their COVID vaccine at a pharmacy rather than a clinician’s office, and pharmacists operate under state laws. Some of those laws explicitly tie a pharmacist’s scope of practice to a CDC recommendation (not the professional societies’). Walgreens says it will let people self-attest that they meet the criteria in every state except Arizona and Oregon, where a prescription is still required. CVS says its pharmacists will use “shared clinical decision-making” without confirming whether self-attestation counts. Walmart says it will require prescriptions in some states, but has not mentioned specifics.

What we don’t know yet

We’ve gotten several questions, and a lot of them are still open-ended at this time. Our colleague Dorit Reiss has been tracking the legal side of all of this in detail, and we will link a state-by-state pharmacy breakdown as soon as a reliable one exists. Here’s where we stand right now:

1. Which states will end up requiring a prescription. The chain policies above are the chains’ own interpretations of the legality, and it has changed week to week in prior seasons. 
2. Whether private insurance covers it. In the absence of a CDC recommendation, private insurers are not obligated to cover the vaccine. AHIP, the trade group that includes most major insurers, says its members will pay anyway, and UnitedHealthcare (not an AHIP member) says the same. Employer-sponsored plans can differ from their parent company, so we recommend checking your plan’s specifications before you go.
3. Vaccines for Children (VFC). Roughly half of American children get their vaccines through VFC, and the CDC ships those doses. Without a CDC recommendation, no one has said publicly whether those shipments will happen, and the Department of Health and Human Services (HHS), which oversees the CDC, has not answered questions about it. We have heard from sources we trust that COVID vaccines will in fact be available through VFC this season but can’t point to written documentation at this time. In the meantime, it’s always worth checking with your clinician to see what he or she can actually order,
4. How much of this is a moving target. Availability changed significantly around this time last year, so if your pharmacy’s schedule is showing no available appointments today, keep checking.

The Consequences of Childhood Vaccine Policy Whiplash

We went through the new kindergarten coverage numbers last week. In brief, exemptions from at least one vaccine rose to 4.2% from 3.6%, and coverage of the measles, mumps, and rubella vaccine fell to 92.4%.

The Pennsylvania story has moved considerably since we wrote about it. Two unvaccinated Lancaster County residents died after contracting measles in August, marking the state’s first measles deaths in 35 years and the first in the country this year. One was a newborn, and the county coroner yesterday confirmed the second death also involved a child. Pennsylvania reported the deaths to the CDC through the standard notifiable-disease process and classified them as measles-associated, which is a term used when lab or epidemiologic evidence of measles is present but not named as the immediate cause of death. The CDC’s weekly measles update, which is posted every Friday, did not appear. It was finally posted on Sunday, where the two deaths were excluded from the report with an asterisk noting that the relative contribution of measles to the deaths was unclear.

The New York Timesreported that Dr. Erica Schwartz, confirmed as CDC director this month, ordered that note be added and directed agency officials to challenge the state’s report. Reuters reported today that HHS Secretary Robert F. Kennedy Jr. asked Schwartz to remove the deaths and that she complied, even though CDC staff had already accepted the state’s finding.

Death investigations are not within the purview of the CDC, so they rely on local health departments to do those investigations accurately and report their findings—this is how the national disease surveillance system has worked for many, many years. Dr. Anne Zink, Alaska’s former chief medical officer, said she could not recall the CDC ever publicly questioning a state’s cause-of-death determination. The concern extends beyond Pennsylvania, as many states are already holding back data due to concerns about how it will be used. 

Here’s What Else We’re Watching

• The request for information on vaccine categories is still open. We walked through what’s at stake last week, including coverage and VFC eligibility. Submit through Regulations.gov by searching Docket No. HHS-OS-2026-0332. Comments are posted publicly, so don’t include anything you wouldn’t want online—they’re due September 20.
• The federal autism advisory committee (again) raised vaccines as a possible cause of autism at its August 27th meeting, despite existing evidence that there is no association. Ultimately, the committee’s strategic plan moved in a different direction, steering funding toward less well-understood areas like diet and folate-based therapies.

Almost every story in this piece is a similar argument in different clothes. They aren’t arguments about whether vaccines work, because evidence continues to support that as consistently as it ever has. It’s more an argument around who gets to say what’s true, who writes the recommendations, and who counts the deaths.

You can’t “correct” your way out of those in the same way you can correct a false claim. You may be looking for information in different places, but the societies and initiatives like the Vaccine Integrity Project are still doing the work, as are the states who are keeping count. And ultimately, your own clinician knows your history better than a federal document ever will.

What are you hearing from your own clinicians and school nurses this month? Any vaccine concerns? Don’t forget to share them with us in the comments, or email us at vaccines@unbiasedscience.com. 

Stay Curious,

Unbiased Science