US vaccine coverage stalls as ACIP remains vacant

A $40 co-pay is the new reality for some Americans seeking the latest influenza protection. Ron Kroening, a 63-year-old retired public health employee with asthma, recently paid that amount out of pocket for a new mRNA flu vaccine. His insurer refused to cover the cost because the shot is not yet listed by the federal advisory panel that determines which vaccines are covered by insurance plans.

The lack of coverage stems from a vacancy in the Advisory Committee on Immunization Practices, or ACIP. Robert F. Kennedy Jr., the secretary of the Department of Health and Human Services, has not nominated any new members to the committee. A judge previously halted Kennedy’s earlier efforts to replace experts with allies, ruling that the process was flawed. Since that order, the committee has sat empty, preventing the issuance of new recommendations even as the Food and Drug Administration approves new vaccines.

The delay creates a timeline where full insurance coverage could be years away. Insurers typically have one year from an ACIP recommendation to cover a vaccine by the next plan year. If a recommendation arrives in December 2026, coverage would not begin until January 2028. A recommendation in January 2027 would push that date to January 2029. Lindsay Wiley, a law professor at UCLA, noted that a recommendation next year would be the best-case scenario, but there is no guarantee one will happen.

This uncertainty affects access to modern treatments. The FDA approved Moderna’s new mRNA flu vaccine in August for people 50 and older. Trials indicate it offers stronger protection than traditional shots. For patients like Kroening, the financial barrier is just one part of the problem. He had to search for a specific pharmacy in his area that stocked the vaccine. He described the current state of vaccination policy as a mess.

The impact extends beyond flu shots. The gap in ACIP guidance has other consequences for the healthcare system. Some states prohibit pharmacists from administering vaccines without an ACIP recommendation. The committee’s pre-disbandment decisions, including a September 2025 recommendation on new RSV shots, were also halted by the court, although insurers appear to be covering those shots anyway. A voided vote to end the universal hepatitis B birth dose is now influencing potential state laws. Medicare coverage for new flu shots for seniors has also faced reported delays, despite legal requirements that do not rely on ACIP recommendations.

Government officials are not moving quickly to fix the situation. The administration has appealed the part of the court ruling that disbanded the committee. Aaron Siri, a lawyer who has represented Kennedy, wrote on Monday that the White House and the Department of Justice are not making a serious attempt to revive the committee. Dorit Reiss, a vaccines expert at UC Law San Francisco, agreed that the federal government is choosing not to install a new ACIP.

Reiss suggested that an empty committee may suit Kennedy’s policy goals. His original appointees did not move as quickly as he wanted to change the vaccination schedule. By bypassing the committee and delaying its reconstitution, Kennedy may be positioning himself to make his own recommendations. Reiss warned that trust in the committee’s independence has been damaged and that restoring it may eventually require a statute to protect its autonomy.

Insurers are navigating this gap in different ways. The industry group AHIP, which includes Kroening’s insurer, has vowed to keep covering all shots recommended as of September 2025. Insurers can also choose to cover vaccines before they are legally required to do so. Kroening said he would still choose the new vaccine and is glad he paid for it, but he remains unhappy that his insurance did not cover the cost.

Experts say the uncertainty could last for years. The combination of legal challenges, policy overhauls, and an empty committee has created a backlog in vaccine recommendations. Until new members are appointed and the process is formally restarted, patients and insurers will continue to operate without clear federal guidance on which new shots are covered.