A Pharmacy Student's Guide to Navigating Available Immunization Recommendations

Vaccine schedules are important to ensure that all individuals are properly protected from infections. A vaccine schedule is like a map; it helps people navigate recommendations by providing expert, science-based guidance on which vaccines to get and when to receive them. Many vaccine schedules exist in the US, creating a challenge for pharmacists to select the appropriate one. Developing a vaccine schedule involves considering the characteristics of the pathogens, the clinical recommendations, and potential patient-specific considerations.¹

This guide is meant to increase awareness of the different organizations that have recently produced vaccine schedules to support patient care by pharmacists and students.

Organizations That Influence Vaccine Schedules

FDA

Vaccine schedules are considered recommendations. Before a vaccine can be recommended, it needs to be approved for use in the US. The FDA, a federal agency of the US Department of Health and Human Services (HHS), is responsible for protecting public health by regulating and ensuring the safety, effectiveness, and security of human and veterinary drugs, medical devices, food, cosmetics, and tobacco products.²

CDC

The CDC is a US government agency that focuses on public health. It works to gather information, create tools, and provide expertise to promote and respond to health threats. The Advisory Committee on Immunization Practices (ACIP) is a separate collection of health officials who make recommendations to the CDC. It has a board of up to 19 voting members, upon the recommendation of the HHS secretary. ACIP members are typically independent medical and public health experts not employed by the CDC.

ACIP also has 6 nonvoting members who represent other federal agencies.³ On June 13, 2025, 6 new voting members were brought in to replace existing independent members. These 6 members recommended the newest vaccine schedule. One such example of change is that there is no recommendation for children and adolescents to receive a COVID-19 vaccine; instead, the CDC emphasizes shared clinical decision-making.⁴ For adults aged
19 to 64 years, the CDC recommends at least 1 dose of the 2025-2026 vaccine, and for adults 65 years or older, they recommend 2 or more doses of this season’s vaccine.⁵

American Academy of Family Physicians

The American Academy of Family Physicians (AAFP) is a professional organization for family physicians, residents, and medical students that provides continuing medical
education, clinical guidelines, and a job board. It publishes a variety of materials, including the journal American Family Physician. AAFP vaccine recommendations are developed by the Commission on Health of the Public and Science (CHPS). The academy members elect AAFP’s Congress of Delegates (COD). The COD elects the board of directors, which appoints physicians, residents, and students from all over the country to serve 2-year terms on the CHPS to form their vaccine schedule based on federal guidance (ACIP and US Preventive Services Task Force).⁶

Regarding COVID-19, the AAFP recommends that those aged 6 to 23 months and 19 to 64 years should receive at least 1 dose of the 2025-2026 COVID-19 vaccine. Patients 65 years or older are recommended to receive 2 or more doses. Additionally, for those aged 2 to 18 years, the AAFP recommends shared clinical decision-making, unless the patient is considered high risk.⁷

American Academy of Pediatrics

The American Academy of Pediatrics (AAP) is a professional organization of pediatricians, pediatric medical subspecialists, and pediatric surgical specialists who are committed to the health and well-being of children. They select a group of experts to form a committee to investigate the current available data and use those data to create their vaccine schedule. All the findings of the committee are peer reviewed before being published.⁸ Unlike the previous organizations, AAP classifies its recommendations based on comorbidities. They recommend at least 1 dose of the 2025-2026 COVID-19 vaccine for patients with one of the following criteria: pregnancy; HIV infection and a CD4 percentage of 15% or greater and a count less than 200 cells/mm³; cerebrospinal fluid leak of cochlear implant; asplenia or persistent complement component deficiencies; heart disease or chronic lung disease; kidney failure, end-stage renal disease, or being on dialysis; chronic liver disease; and diabetes.

For patients who are moderately to severely immunocompromised, there are different recommendations based on age and previous vaccination status. The AAP has recommendations for immunocompromised patients as young as 6 months and up to 18 years, and also discusses those with special situations (eg, COVID-19 infection, living in a high-risk household).⁹

American College of Obstetricians and Gynecologists

The American College of Obstetricians and Gynecologists (ACOG) is a professional organization for obstetrician-gynecologists and other women’s health care professionals in the US and Latin America. It provides resources, clinical guidance, and patient education materials on topics such as contraception and health issues related to women. Its vaccine schedule is created by infectious disease and immunization experts. They create separate schedules for COVID-19, respiratory syncytial virus, and influenza.¹⁰ Additionally, ACOG works closely with the Vaccine Integrity Project (VIP) to create its schedules.¹¹

For pregnant people, ACOG recommends receiving the updated COVID-19 vaccine for the 2025-2026 season. It recommends that COVID-19 immunization is appropriate for pregnant people during any trimester and that they should receive it as soon as possible. ACOG also communicates the safety of the vaccine for pregnant people and the benefits of vaccination.¹²

VIP

VIP is an initiative that is dedicated to safeguarding vaccine use. It originated from the Center for Infectious Disease Research and Policy at the University of Minnesota. It provides trusted, science-based information for health care providers and policy makers to make informed decisions about vaccines. A team of epidemiology, infectious diseases, and evidence review experts assembled to look at recently published information. VIP focuses on rapidly responding to misleading public health-related information, develops and disseminates the evidence base for vaccine recommendations, and fosters collaboration and visibility. Some information is separated based on pregnancy status, age, and whether one is immunocompromised. It provides links to ACOG and AAFP recommendations for pregnant people, AAP and AAFP recommendations for infants and children, AAFP recommendations for adults and older individuals, and Infectious Diseases Society of America recommendations for immunocompromised patients.¹³

Recommendations Are Changing by State

Because of the discrepancy among the different organizations and the distrust that has grown in government-based agencies, some states have expanded beyond strictly following the ACIP/CDC vaccine recommendations. For example, in New Jersey, COVID-19 vaccine recommendations differ from CDC recommendations.¹⁴ New Jersey now recommends that everyone statewide who is 6 months or older should receive a COVID-19 vaccine, particularly those 65 years or older or those who are considered high-risk. On the official New Jersey government website, there are links for uninsured or low-resource patients to receive the vaccine free of charge and information for patients who are homebound.¹⁵ New Jersey is not the only state shifting their recommendations. Minnesota and New York have also updated their vaccine policies surrounding COVID-19.¹⁴

Conclusion

With many recent changes in vaccine recommendations, it is important for pharmacists and student pharmacists to understand how various agencies and government entities establish their vaccine recommendations. Patients trust their pharmacists, and it is essential for patient health and well-being to be knowledgeable about appropriate vaccine use.

REFERENCES

1. Offit PA. Science behind the vaccine schedule. Children’s Hospital of Philadelphia. November 6, 2025. Updated February 2, 2026. Accessed November 7, 2025. https://www.chop.edu/vaccine-education-center/vaccine-schedule/science-behind-vaccine-schedule

2. Vaccines. FDA. Updated January 15, 2025. Accessed November 7, 2025. https://www.fda.gov/vaccines-blood-biologics/vaccines

3. ACIP committee members. CDC. September 17, 2024. Accessed November 7, 2025. https://www.cdc.gov/acip/membership/index.html

4. Child immunization schedule notes. CDC. 2024. Accessed November 7, 2025. https://www.cdc.gov/vaccines/hcp/imz-schedules/child-adolescent-notes.html#note-covid-19

5. Healthcare professionals: adult immunization schedule by age. CDC. June 27, 2024. Accessed November 7, 2025. https://www.cdc.gov/vaccines/hcp/imz-schedules/adult-age.html

6. Moore D, Ramas ME. Keeping our vaccine recommendations reliable and trustworthy. American Academy of Family Physicians. September 23, 2025. Accessed November 7, 2025. https://www.aafp.org/news/blogs/aafp-voices/immunization-guidance.html

7. Immunization schedules. American Academy of Family Physicians. Accessed November 7, 2025. https://www.aafp.org/family-physician/patient-care/prevention-wellness/immunizations-vaccines/immunization-schedules.html

8. Jenco M. AAP releases evidence-based immunization schedule; calls on payers to cover recommendations. News release. American Academy of Pediatrics. August 19, 2025. Accessed November 7, 2025. https://publications.aap.org/aapnews/news/32835/AAP-releases-evidence-based-immunization-schedule

9. Recommended Child and Adolescent Immunization Schedule for Ages 18 Years or Younger. American Academy of Pediatrics. Accessed November 7, 2025. https://downloads.aap.org/AAP/PDF/AAP-Immunization-Schedule.pdf

10. ACOG to release recommendations on COVID-19 vaccine and other maternal immunizations in concert with the Vaccine Integrity Project. News release. American College of Obstetricians and Gynecologists. July 16, 2025. Accessed November 7, 2025. https://www.acog.org/news/news-releases/2025/07/acog-to-release-recommendations-on-covid-19-vaccine-and-other-maternal-immunizations-in-concert-with-the-vaccine-integrity-project

11. ACOG releases updated maternal immunization guidance for COVID-19, influenza, and RSV. News release. American College of Obstetricians and Gynecologists. August 22, 2025. Accessed November 7, 2025. https://www.acog.org/news/news-releases/2025/08/acog-releases-updated-maternal-immunization-guidance-covid-influenza-rsv

12. COVID-19 vaccines and pregnancy: conversation guide. American College of Obstetricians and Gynecologists. Updated August 2025. Accessed November 7, 2025. https://www.acog.org/programs/immunization-infectious-disease-public-health/tools-and-resources/covid-19-vaccines-and-pregnancy-conversation-guide-for-clinicians

13. Vaccine Integrity Project - 2025-26 fall immunization information. University of Minnesota Center for Infectious Disease Research and Policy. 2025. Accessed November 7, 2025. https://www.cidrap.umn.edu/vaccine-integrity-project/immunization-info

14. Kekatos M. New Jersey becomes latest state to expand access to COVID-19 vaccines. ABC News. September 10, 2025. Accessed November 7, 2025. https://abcnews.go.com/Health/new-jersey-latest-state-expand-access-covid-19/story?id=125444856

15. COVID-19 vaccines. State of New Jersey. 2025. Accessed November 7, 2025. https://www.nj.gov/health/covid-19/information/vaccines/