Kelly Moore, MD, MPH: A Past Voting Member of the ACIP Discusses the End of Universal Recommendation for COVID-19 Vaccination

In September 2025, the US Advisory Committee on Immunization Practices (ACIP) adopted a marked change to vaccination recommendations: in place of supporting the existing broad, population-wide recommendation for COVID-19 vaccination, the committee voted on a shared clinical decision making paradigm—placing the onus on clinicians and patients to weigh risks, benefits, and individual context. This shift marks a departure from the more traditional ACIP model, where a clear universal recommendation would guide coverage, reimbursement, and standard of care. The decision has sparked intense debate within the immunization community—on scientific rigor, interpretability, access, and public trust.

Patient Care turned to Kelly Moore, MD, MPH, president and CEO of immunize.org, to unpack the rationale and implications of ACIP’s vote. With her background as a former ACIP voting member and deep roots in vaccine program implementation and immunization education, Moore is well positioned to assess both the scientific and practical dimensions of the change.

Our conversation explores several interlocking themes:

• the scientific evidence (or gaps) that prompted ACIP to deviate from its usual Evidence to Recommendations (EtR) framework
• how clinicians should interpret “shared decision making” in daily practice, especially in settings already burdened with competing priorities
• the challenge of communicating nuance without sowing confusion or undermining vaccine confidence
• and the broader public health calculus—what happens if uptake slips, or the next variant is more virulent or unpredictable?

For health care professionals navigating COVID-19 vaccination in 2025, Moore emphasized what has changed—and what remains constant: namely, the central role of trusted clinicians in safeguarding patient and community health. As you read, consider how this tension between standard recommendation and individualized care will play out in your practice and in public health systems.

The following transcript has been lightly edited for flow and style.

Patient Care: The first question I'd like to ask is, what the immunized debt or position is on the Advisory Committee on Immunization Practices (ACIP) vote that a recommendation for COVID-19 vaccination be made through a shared decision making process versus guidance for universal coverage?

Kelly L Moore, MD, MPH: I am speaking more as a former voting member of the a CIP who's been in the position of making these decisions in the past and observing the committee's actions and the fact that they did not use the usual evidence to recommendations framework that's used to guide policy decisions. They didn't use the ACIP's grading of evidence to determine the quality of evidence that they're discussing. Also, a lot of the new members are not experts in vaccinology or vaccine program implementation, so they're really inexperienced to make these kinds of decisions.

So although it is very clear that there are certain groups in the population who are at increased risk of severe COVID disease and really should be vaccinated regularly to protect them, including those at the extremes of life, the very young and the very old, as well as those with immunocompromising conditions or other serious health problems, I don't think this committee was equipped to adequately evaluate those groups, and as a result, I'm relieved to see that what they did with shared clinical decision making, at least, does not close the door on any group that any person who feels the need for vaccination, and it doesn't prevent a health care professional from offering vaccination to patients they feel need it. Unfortunately, this means that health care professionals are going to need to look for specific guidance from our professional medical societies, whether that's the American College of Physicians or American Academy of Family Physicians or the American Academy of Pediatrics.