US Vaccine Panel Vacancy Delays New Flu Shot Coverage

Robert F Kennedy Jr, the secretary of the Department of Health and Human Services, has left the federal Advisory Committee on Immunization Practices, or ACIP, without appointed members. This vacancy halts the process for recommending new vaccines, leaving insurers without a clear timeline for adding coverage. The uncertainty affects access to shots like the new mRNA flu vaccine approved by the Food and Drug Administration in August for adults 50 and older.

Ron Kroening, 63, experienced this gap when his doctor suggested the new Moderna flu shot. He had asthma and severe allergies that season. Kroening found only one pharmacy in his area stocking the vaccine. His insurer told him the shot was not covered because it lacked an ACIP recommendation, forcing him to pay a $40 co-pay. Kroening, a retired public health employee from Oklahoma, noted that any barrier to vaccination discourages people from getting shots.

Normally, insurers have a year or more to add coverage after a vaccine is recommended. The ACIP recommendation usually triggers coverage by the next plan year, which starts in January. A recommendation in December 2026 would require coverage by January 2028. A recommendation in January 2027 would push that deadline to January 2029. Lindsay Wiley, a law professor at UCLA, stated that a recommendation next year represents the best-case scenario for the new flu shot, though she does not expect one.

Covid vaccines are an exception because Congress amended the Affordable Care Act to require coverage within 15 days of an ACIP recommendation. The current gap affects other areas as well. Some states prohibit pharmacists from administering vaccines without an ACIP recommendation. The committee's September 2025 recommendation on new RSV shots was halted, although insurers appear to be covering those shots anyway. A voided vote to end the universal hepatitis B birth dose is also influencing state laws.

Delays have been reported in Medicare coverage for the new flu shots for seniors, even though federal law requires coverage without a specific recommendation. The government appealed the court order that disbanded the committee, but experts say nothing prevents Kennedy from appointing new members through the correct process. Aaron Siri, a lawyer who has represented Kennedy, wrote on Monday that the White House and the Department of Justice are not making a serious attempt to revive the committee.

Dorit Reiss, a vaccines expert at UC Law San Francisco, agreed that the federal government is choosing not to install a new ACIP. She suggested that an empty committee may suit Kennedy, whose previous appointees did not change the schedule as quickly as he wanted. Bypassing the committee and delaying its reconstitution could allow him to make his own recommendations. Reiss warned that the committee's future remains shaky even after the court case ends because trust in its independence has been undermined. She said restoring it may require a statute giving it protection.

Kroening's insurer is part of the industry group AHIP, which has vowed to keep covering all shots recommended as of September 2025. Insurers can choose to cover vaccines before they are legally required to do so. Kroening said he would still choose the new vaccine and is glad he paid for it. He remains unhappy that his insurance did not cover the cost. He described the current situation as a mess.