Fall shots without a federal referee — the pediatricians' guidance is out, and here is what it means at the pharmacy
The American Academy of Pediatrics published its COVID-19 and RSV recommendations today, filling a gap the CDC's advisory committee has left open. The medicine is straightforward. Getting the shot, and getting it paid for, depends on your state and your pharmacy.
For decades the fall respiratory season ran on one calendar. The CDC's Advisory Committee on Immunization Practices voted, insurers were required to cover whatever it recommended at no cost, pharmacists in every state were authorized to give it, and your doctor followed the schedule. This year there is no functioning ACIP. Its 2025 votes are tied up in court, no quorum has been seated, and the referee's chair is empty.
Into that space stepped the professional societies. The American Academy of Pediatrics released flu guidance in August and, today, its COVID-19 and RSV policy statements in Pediatrics. Family physicians, obstetricians and the infectious disease societies have done the same for adults. If you want to know what to get and when, the answer exists. It just does not come from Atlanta.
- Under 2: AAP recommends the updated COVID-19 vaccine for all children 6–23 months; risk-based for ages 2–17
- Infants under 8 months: one dose of nirsevimab or clesrovimab before or during RSV season, unless the mother was vaccinated in pregnancy
- Pregnancy: RSV vaccine at 32–36 weeks, 75–89% effective at protecting the newborn
- Adults 75+ and high-risk 50+: one RSV dose, not annual — skip it if you already had one
- Formula: this year's COVID vaccine targets XFG, an Omicron subvariant
- Co-administration: flu, COVID and RSV together is safe, per data on 454,000 people
(Sources: American Academy of Pediatrics, Your Local Epidemiologist, CIDRAP, ACOG, IDSA)
The recommendations themselves
For babies, the RSV story is the clearest win in preventive medicine of the last five years. A single antibody shot — nirsevimab or clesrovimab — cuts severe RSV about 90%, and babies born during the season should get it within a week of birth, ideally before leaving the hospital. Children 8 to 19 months at high risk get nirsevimab going into their second season. The alternative is a vaccine for the mother between 32 and 36 weeks of pregnancy, which protects the infant for about six months.
For COVID-19, the AAP's position is universal for the youngest children and risk-based above age 2. For adults, the internal medicine and infectious disease societies recommend the updated vaccine broadly, with the strongest case for people over 65, immunocompromised patients and anyone living with them. Timing advice is the same as last year: if you had COVID recently, waiting four to six months is reasonable; otherwise, October and November cover the winter wave.
Why the empty chair matters at the counter
Here is the part the medical guidance cannot fix. Two things in American vaccine policy hang off an ACIP recommendation: the Affordable Care Act's no-cost coverage requirement, and pharmacists' authority to vaccinate in many states. With the committee's recent votes stayed by a court and no new ones taken, both are running on older rules and workarounds.
On cost, the practical answer is better than the legal one. Insurers, Medicare and the Vaccines for Children program have said they will continue covering flu, COVID and RSV vaccines without cost-sharing this fall. Your plan almost certainly covers it. But "almost certainly" is not the same as "required by law," so if a bill shows up, do not pay it — appeal it. Our guide to free preventive care explains which services must be covered and how to fight a wrongful charge.
On access, it varies by state. Pharmacy chains report giving the updated COVID vaccine without a prescription in roughly two-thirds of states, requiring one in about sixteen, and being unable to give it at all in a few — Massachusetts, Nevada and New Mexico were named — because state pharmacy law ties authority to the federal schedule. In those states, the shot is available; it just requires a doctor's office or a clinic rather than the drugstore.
What to do this month
If you are pregnant, ask your OB about the RSV vaccine at your 32-week visit — it is the single decision that most protects the baby. If you have a newborn or an infant under 8 months, ask the pediatrician about the antibody shot now; supply was the constraint two years ago and clinics order early. If you are over 75, or over 50 with heart or lung disease, and have never had the RSV vaccine, get it once and be done.
For flu and COVID, plan for October. Call the pharmacy first and ask two questions: do you need a prescription in this state, and is it billed as preventive with no copay. If the answer to the first is yes, a telehealth visit can usually produce one the same day — see our guide to telehealth. If you do not have a regular doctor to ask, this is a reasonable season to fix that; our guide on finding a primary care doctor is the place to start.
The science did not change this year. The plumbing did. Knowing which is which is most of the job.