Kelly Moore, MD, MPH, is Concerned About COVID-19 Vaccination Equity in Post-Universal Coverage America

This September, the Advisory Committee on Immunization Practices (ACIP) of the CDC voted unanimously to replace universal COVID-19 vaccine recommendations with a shared clinical decision-making approach. The change applies to adults 65 and older, as well as all individuals 6 months and up.

In a recent conversation with Patient Care,^© Kelly Moore, MD, MPH, president and CEO of immunize.org, reflected on the sharp departure from the broad public health guidance that had shaped the response to COVID-19 since 2020. She emphasized that the new passive recommendations will likely exacerbate already persistent disparities in vaccine access and coverage in the US, particularly among individuals without regular healthcare contact or the means to advocate for preventive services.

Moore's comments underscore a critical tension in contemporary public health policy: balancing individualized care with population-level protection, particularly for those who face barriers to healthcare access and lack the resources or connections to advocate for their own preventive care needs.

The following transcript has been lightly edited for flow.

Patient Care: How does the decision to end universal COVID-19 vaccine coverage intersect with public health efforts to reduce disparities in vaccine access and uptake?

Kelly L Moore, MD, MPH: We're concerned about vaccine access from the standpoint that members of the general public look to federal agencies and published guidelines to ask, "Do I really need this vaccine?" There is a small subset of the population who definitely understands that they need the vaccine and will go out and seek it. However, there are a lot of people who could benefit from vaccination who may be much less aware; they may not encounter a primary care health care professional very often, so they don't get to hear the message that this is actually important for them. I'm concerned that, for that reason, this kind of passive recommendation, a permissive recommendation, is not going to reach the people who are who have less access to health care, and that they may not go out and seek this for themselves. So I think ultimately we're going to see growing disparities in who gets the vaccine; the people who are well informed and well connected to health care systems are much more likely to get the vaccine than people who are not.

Kelly L Moore, MD, MPH, is the president and CEO of Immunize.org and a leader in national and global vaccine policy and immunization program implementation. She has served in a variety of immunization policy advisory roles with the World Health Organization since 2016, including as chair of its Immunization Practices Advisory Committee. She has a long history with the ACIP as a working group member, liaison representative of the Association of Immunization Managers (2011–2015), and as a voting member (2015–2019).