For clinicians heading into the 2026-2027 respiratory vaccination season, the challenge is no longer just knowing the recommendations. It is also knowing which guidance to trust, how that guidance was developed, and how to discuss it with patients amid an evolving U.S. vaccine policy environment.
Those issues were the focus of “Navigating the 2026/2027 U.S. Respiratory Vaccine Recommendations in a Changing Public Health Landscape,” a John G. Bartlett Memorial Webinar Series session hosted by the IDSA Foundation.
“[These are] challenging and unprecedented times,” commented Jason M. Goldman, MD, MACP, FRCP, FPCP (Hon), who provided the clinical perspective during the session. He was joined by experts addressing the public health and legal dimensions of the changing vaccine landscape.
A changing vaccine recommendation process
Demetre Daskalakis, MD, MPH, chief medical officer of Callen-Lorde Community Health Center in New York, described the longstanding U.S. vaccination strategy as a “moonshot” toward zero cases of vaccine-preventable diseases and, consequently, zero related complications and deaths. Achieving that goal, he said, depends not only on scientific advances but also on how evidence is translated into vaccine recommendations.
After vaccines were evaluated for safety and effectiveness in clinical trials and reviewed and licensed by the Food and Drug Administration, the Centers for Disease Control and Prevention’s expert-led Advisory Committee on Immunization Practices traditionally conducted a structured review to develop recommendations, he explained. Within this process, the Committee graded the available evidence using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach before applying an evidence-to-recommendations framework that considered factors such as the public health problem, benefits and harms, values, acceptability, resource use, equity and feasibility.
“All of those domains were looked at methodically to make sure that the vaccine policy worked,” Dr. Daskalakis said. “But in 2025, that all broke down.”
He pointed to the dismissal of all ACIP members and their replacement with individuals with “little or no vaccine expertise,” as well as recommendations that he said were made without the usual scientific methodology or based on evidence that raised scientific concerns, including changes to the COVID-19 vaccination recommendations; the removal of thimerosal from influenza vaccines; and the end of the universal hepatitis B birth-dose recommendation.
The changes also extended to the childhood immunization schedule, with HHS drawing on Denmark’s minimalist vaccination recommendations — an approach Dr. Daskalakis criticized because of differences between the countries’ health care systems and social policies.
“A lot of this was happening by decree, by an executive order that was then followed, rather than [through] a process that involved science, scientist, order, and methodology,” he said. In response, he pointed to an alternative evidence-based respiratory virus immunization schedule developed by a coalition of professional societies, including IDSA.
Professional societies step in
Among those responding to the changing vaccine guidance landscape, the American College of Physicians developed rapid practice points for influenza, COVID-19 and RSV vaccination, focusing on adults who were neither pregnant nor immunocompromised. Dr. Goldman, who is immediate past president of ACP and served as the ACP liaison to ACIP, described the evidence reviews underlying that guidance.
“While [our response] was rapid, we did not shortchange the data or evidence review,” he said.
As a designated GRADE and AGREE (Appraisal of Guidelines for Research and Evaluation) Center, ACP reviewed the best available evidence on vaccine benefits and harms, including relevant clinical outcomes and, where applicable, comparisons between vaccine formulations.
Based on those reviews, ACP’s practice points included:
Influenza: Adults aged 18 to 64 years should receive a standard-dose trivalent or quadrivalent vaccine. Those aged 65 years or older should receive a high-dose trivalent or quadrivalent egg-based vaccine.
COVID-19: All adults aged 65 years or older and those aged 18 to 64 years at increased risk for COVID-19 should receive the updated mRNA-based vaccine. Adults aged 18 to 64 years who are not at increased risk may consider vaccination.
RSV: Adults aged 75 years or older should receive a protein subunit vaccine. Those aged 60 to 74 years at increased risk for severe RSV may consider receiving one.
ACP also provides clinical guidance and resources, including an immunization hub that continues to feature the previously endorsed ACIP immunization schedule rather than the current schedule, Dr. Goldman said. The society also advocates at the state and federal levels to preserve access to vaccines, providing its members with toolkits to support those efforts.
“[We and our fellow professional societies] cannot fully encompass all the work that had been done previously on a truly functional [ACIP], which is why it is so important to get back to a place where we have the information, data, evidence-to-recommendation framework and a pathway to be able to make these scientific, evidence-based vaccine recommendations,” Dr. Goldman concluded. “It is imperative for us as physicians to have the guidelines and for our patients to get the vaccines that they need.”
Vaccine policy on trial
“But there’s another layer here,” said session moderator Mati Hlatshwayo Davis, MD, MPH, FIDSA, a member of the IDSA Board of Directors and executive vice president and chief strategy officer at Missouri Foundation for Health. “Even when we know what [the] evidence says and what professional societies recommend, clinicians and health systems are still operating inside a legal and regulatory environment that determines what can actually happen.”
Richard Hughes IV, JD, MPH, addressed that legal dimension. A partner at Epstein Becker Green and professorial lecturer at The George Washington University Law School, he serves as lead counsel in American Academy of Pediatrics et al. v. Kennedy et al. — a case challenging federal actions affecting vaccine recommendations and the advisory process.
Hughes reviewed the case and noted that a judge issued a stay order in March covering:
The January HHS-issued childhood immunization schedule;
The membership of 13 ACIP members; and
All ACIP votes since the committee was reconstituted in June 2025.
The May 2025 secretarial directive rescinding routine COVID-19 vaccine recommendations for healthy children and pregnant individuals remained unresolved.
The government appealed specific aspects of the decision, with oral argument scheduled for October 6, Hughes said.
“This is a case as much about the rule of law and administrative law and following processes and procedures,” he remarked. “The secretary has a lot of authority, but it’s not unchecked. He can’t just unilaterally make the kinds of changes that he’s making. He can’t flout the kinds of processes that [Dr. Daskalakis] described.”
He concluded, “I’m very proud to see that the judge in our case really emphasized the importance of following the [evidence-to-recommendation framework], following those processes and procedures. I'm very hopeful that we’ll ultimately have a final decision that helps restore sanity in vaccine policy.”
Bringing the guidance into clinic
“When clinicians are faced with uncertainty or competing sources of guidance, saying ‘follow the evidence’ is just not enough,” Dr. Hlatshwayo Davis said.
She brought the public health, clinical and legal perspectives together to address how clinicians can navigate these challenges: “Clinicians aren’t being asked to become policy experts or lawyers, but we do need to understand enough about [the] landscape to know what guidance we are relying on, why we trust it and how we need to implement it.”
Asked by the IDSA Reporter how clinicians should counsel patients who are confused or distrustful because of changing recommendations, Dr. Daskalakis advised them to “be clear that your recommendations are based in the best science” and well-researched information. “We need to expect that those conversations are going to be more complex, and we have to listen as much as we speak,” he added.
Dr. Goldman reported no conflicts of interest. Dr. Daskalakis, Hughes, and Dr. Hlatshwayo Davis did not provide disclosure information during the webinar.
Disclaimer: Views and opinions expressed by webinar speakers and moderators do not necessarily reflect the official positions or views of IDSA or Conexiant and should not be interpreted as endorsement of a particular article or viewpoint.