The American Academy of Pediatrics (AAP) is issuing its own guidance on COVID-19 vaccines for young children, diverging from recommendations from the Centers for Disease Control and Prevention. On Tuesday, the AAP said all children ages 6 months to 23 months, including those considered high risk, should receive a COVID-19 shot, citing evidence that the vaccine provides an added layer of protection.
Most children hospitalized between 2022 and 2024 with COVID-19 were 6 months and older with at least one underlying health condition, and fewer than 5% were fully vaccinated. The AAP says certain conditions, such as chronic lung disease, heart problems or weakened immune systems, put children at higher risk for severe illness.
The recommendation did not come lightly. Dr. Sean T. O’Leary of the AAP’s Committee on Infectious Diseases said that although we aren’t in the same place we were four or five years ago, with the pandemic for older children, “the risk of hospitalization for young children and those with high-risk conditions remains pretty high.”
Download the SAN app today to stay up-to-date with Unbiased. Straight Facts™.
Point phone camera here
CDC guidance diverges
It is not new for the AAP to release its own recommendations for parents and health care providers. What is different in recent decades is that their guidance now diverges from CDC recommendations.
The CDC says children under age 2 are being hospitalized at rates similar to adults ages 50 to 64, with more than half of those children having no underlying medical conditions.
Despite high hospitalization numbers, the CDC is no longer recommending COVID-19 vaccines for healthy children. Health and Human Services Secretary Robert F. Kennedy Jr. made the announcement in late May, leaving it to parents to discuss with their health care providers whether vaccination is necessary.
Public health perspective: local impact
The differing recommendations leave local health departments navigating how best to advise families.
Adriane Casalotti, chief of government and public affairs at the National Association of County and City Health Officials, told SAN that the changing guidance affects how local health departments provide information.
“We can expect that this will help guide some of those conversations, but some of the practical pieces for health departments is really about ensuring access, ensuring people have the information that they need around what’s available to them and how it could support them in their individual health situation,” she said.
Casalotti said that regardless of the guidance released, part of NACCHO’s role is to understand how updates may affect programs, services and insurance coverage for families and communities.
The guidance also affects insurance coverage. Casalotti said the AAP’s recommendation aligns with guidance from the CDC’s Advisory Committee on Immunization Practices, which helps determine what insurers cover. The ACIP’s latest guidance, issued in 2024, recommends COVID-19 vaccination for everyone 6 months and older for the 2024–2025 season.
“It allows them to be covered, and then it looks like, you know, for the vast majority of Americans, it’s based on our health insurance status, and so insurers are required to cover certain things depending on how they are in the ACIP schedule,” she said. “But they could always choose to cover vaccines, particularly if that’s going to help them in the long run of reducing more costly illness, and hospitalization and death.
Casalotti said the new guidance will help inform conversations between families and their health care providers.
“The main place where folks make their decisions about getting themselves or their loved ones immunized is by talking to their health care provider,” he said.
Legal and policy context
In recent months, the AAP has pushed back against moves by HHS, filing a lawsuit in July after RFK Jr. scrapped vaccine recommendations without presenting scientific data. To maintain continuity, the AAP announced in June that it would keep publishing its own vaccine schedule.
“While the shared clinical decision-making model in the updated immunization schedule preserves families’ choice, this model has consistently proven challenging to implement because it lacks clear guidance for the conversations between a doctor and a family,” said AAP President Dr. Susan J. Kressly.
