Healthier Holidays in 1-2-3

Healthier Holidays in 1-2-3
The Centers for Disease Control and Prevention has updated its approach to COVID-19 vaccination for the 2025-2026 season, shifting from universal recommendations to individual-based decision making, also known as shared clinical decision making. This significant policy change means healthcare providers and patients will now discuss personal risk factors, health history, and preferences to determine whether vaccination is appropriate, rather than following a one-size-fits-all approach for everyone aged six months and older. The updated guidance reflects evolving understanding of the virus as it becomes endemic, along with data showing declining public uptake of previous booster recommendations. According to CDC reports, only about 23% of adults followed the most recent seasonal booster advice, partly due to widespread concerns about the risk-benefit profile as population immunity increased through both vaccination and prior infection. This new framework emphasizes informed consent, allowing doctors to have meaningful conversations about potential benefits and risks tailored to each patient’s circumstances rather than applying blanket recommendations.

Under the revised 2025-2026 guidelines, the recommended number of vaccine doses depends on age, vaccination history, and individual risk factors for severe COVID-19. For adults aged 65 and older, the CDC strongly recommends receiving the updated vaccine, typically one dose annually, though some may need additional doses based on health status. People who are moderately or severely immunocompromised follow a more intensive schedule, often requiring an initial series if unvaccinated followed by two doses per year, with potential for additional doses through shared decision making with their healthcare provider. For individuals under 65, vaccination is particularly encouraged if they have specific risk factors such as chronic lung disease, heart conditions, diabetes, obesity, or other medical issues that increase vulnerability to severe outcomes. The CDC maintains a comprehensive list of these risk factors to help guide discussions. Importantly, people can self-attest to these risk factors when seeking vaccination, ensuring accessibility without unnecessary barriers. Previously vaccinated individuals generally need only one updated dose per season, administered at least eight weeks after their last COVID-19 vaccine, though timing varies slightly depending on which vaccine brand was previously received.

Three updated vaccine options are available for the 2025-2026 season, all targeting current circulating strains descended from the Omicron variant. The Moderna Spikevax vaccine is authorized for everyone aged six months and older, while the newer Moderna mNexspike formulation requires a longer interval between doses. The Pfizer-BioNTech Comirnaty vaccine is available for individuals aged five years and older, and Novavax Nuvaxovid serves those aged twelve and above. Notably, Pfizer’s vaccine is no longer authorized for children between six months and four years, making Moderna the only FDA-approved option for this youngest age group. For children and adolescents, recommendations follow a risk-based strategy where vaccination is prioritized for those with underlying health conditions that increase severe disease risk, such as asthma or diabetes. However, the American Academy of Pediatrics clarifies that even healthy children whose parents wish to provide extra protection can still receive the vaccine through shared decision making with their pediatrician. This approach acknowledges that while hospitalization data shows nearly 45% of children hospitalized for COVID between late 2022 and mid-2024 were aged six to twenty-three months, individual circumstances vary significantly.

The shift to individual-based decision making stems from careful analysis by the CDC’s Advisory Committee on Immunization Practices, which concluded that the risk-benefit profile of vaccination differs substantially across population groups. For older adults and those with certain medical conditions, the benefits of preventing severe illness, hospitalization, and death continue to clearly outweigh potential risks. However, for younger, healthier individuals without risk factors, the committee determined the benefits are more modest given high levels of existing immunity from prior infection and vaccination. This nuanced approach aligns with FDA actions that have narrowed marketing authorization for COVID-19 vaccines to specifically cover individuals aged 65 and older and those with recognized risk factors for severe disease. The timing of vaccination remains important, with healthcare experts recommending administration in late September through October to ensure optimal protection before typical winter surges. It takes up to four weeks for the vaccine to reach full effectiveness, so getting vaccinated before potential exposure waves provides the best defense. Pharmacies and clinics should now offer only the updated 2025-2026 formulations, as older versions no longer provide adequate protection against circulating variants.

This updated guidance represents a maturation in the public health response to COVID-19, moving from emergency pandemic measures toward sustainable, routine vaccination practices similar to those for influenza. The CDC emphasizes that staying up to date with vaccination remains crucial because protection wanes over time, immunity from prior infection decreases, and viral evolution requires updated formulations to maintain effectiveness against current strains. While the recommendation is no longer universal, the agency strongly encourages vaccination for high-risk groups, noting it remains the best tool to prevent severe outcomes. Healthcare providers play a central role in implementing this new framework, using their clinical judgment to discuss options with patients based on individual health profiles. Patients are encouraged to have open conversations with their doctors about their specific situation, including any concerns about vaccine safety or efficacy. Insurance coverage remains in place through 2026 for all ACIP-recommended immunizations with no out-of-pocket costs, ensuring financial barriers don’t prevent access for those who choose vaccination. As with all vaccines, ongoing monitoring continues through the CDC’s robust safety surveillance systems to detect any rare adverse events and ensure the continued favorable risk-benefit profile of these updated vaccines. This personalized approach aims to rebuild trust in vaccination recommendations while maintaining strong protection for those who need it most as the nation transitions to managing COVID-19 as an ongoing public health concern rather than an emergency.