CDC Adds COVID-19 Vaccines to Child Immunization Schedule

Every year, the Centers for Disease Control and Prevention (CDC) teams up with the American Academy of Pediatrics (AAP) and other organizations to update the recommended childhood immunization schedule. Now, for the first time,the COVID-19 vaccineappears on that table.This follows the recommendation from the CDC’s Advisory Committee on Immunization Practices (ACIP) in the fall of 2022.

The guidance from the CDC is ultimately the same as it has been—for everyone over the age of 6 months to receive their primary series of the COVID vaccine as well as boosters.The 2023 immunization schedule just solidifies that. It also points to theCDC's guidance on booster dose vaccinationfor when children should get their boosters. Essentially, when a new booster shot is approved, families should follow the CDC's recommendation for that particular vaccination.

Many parents may understandably be unsure about what this means. Will their child be required to get the COVID vaccine in order to attend school? Will COVID boosters be an annual requirement for kids? As the CDC notes, these are simply recommendations—only states have the power to mandate vaccines for school or otherwise.

Still, many questions still linger. We reached out to experts to help us unpack this news and to help us understand how child immunization schedules work and what the purpose is.

Why Are Childhood Vaccine Schedules Important?

The CDC’s job is to keep track of infectious diseases and make determinations about what vaccines are important for children to receive. “The current childhood vaccine schedule has been carefully crafted and extensively studied,” saysRebekah Diamond, MD, assistant professor of pediatrics at Columbia University, and author of the bookParent Like A Pediatrician.

Dr. Diamond emphasizes the vaccines the CDC recommends for children are the safest and most effective way to protect your child from serious illness. “We know vaccine uptake leads to happy, healthy children through data,” she describes. “As a pediatrician, I’ve also seen it firsthand—treating a devastating disease or even witnessing childhood death from vaccine-preventable disease.”

The CDC’s vaccine schedule also provides guidance for states and institutions like schools, explainsNehali Patel, MD, an associate faculty member at the Infectious Disease Clinic at St. Jude Children’s Research Hospital. “Childhood vaccination schedules are the guidepost for all providers to refer to when offering routine vaccinations,” Dr. Patel describes. “They are also the main resource for parents and schools to see what is recommended for each age group and special circumstance.”

Additionally, Dr. Patel says these recommendations offer key guidelines regarding the number of vaccines in a series to offer, what ages children should start receiving these vaccines, how to space the vaccines out, and how to vaccinate children who havechronic conditionsor are immunocompromised.

How the COVID Vaccine Fits Into Immunization Schedules

The 2023 childhood immunization schedule only says COVID vaccines should be given starting at age 6 months, with boosters to follow. It does not get into details as specific as with other vaccines on the schedule. But caregivers should make sure to follow the CDC's guidelines for boosters, which could be different depending on your child's age and which vaccine they got for their primary series.

“ThePfizer vaccinewill require three doses for first-time recipients who are under 5 years old,” Dr. Patel describes. “TheModernawill require 2 doses.” After that, she expects there will be seasonalCOVID boosters, similar to theflu shot, updated yearly to target circulating COVID variants.

COVID Vaccinations Lag for Children

To date,COVID vaccinationhas lagged in children, especially young children. According to the Academy of American Pediatrics (AAP), as of October 26, 2022, 58% of 12-17 year olds have received two doses of a COVID vaccine, and 31% of 5-11 year-olds have received two doses. The vaccine uptake for 6 months to 4 years old is even lower—only 9% of kids in this age group have received even one COVID vaccine.

Katelyn Jetelina, PhD, an epidemiologist and founder ofYour Local Epidemiologist, shares some thoughts on why this may be happening. “First, I think this has to do with the lagged clinical trials and honestly waiting too long,” she said. “So, many children were already infected by the time vaccinations were available that many parents don’t see the benefit.”

Additionally, compared to adults, children tend to fare better when it comes to COVID infections, which likely has led to a lack of urgency for parents, she says. “However, comparing children to adults is inherently flawed, as kids aren’t supposed to be hospitalized (or die),” Dr. Jetelina emphasizes. This type of messaging hasn’t reached parents with enough clarity, she says.

Finally, Dr. Jetelina thinks there are still quite a few hesitant parents and even hesitant pediatricians. There’s hope, though, she says. “Vaccine confidence takes time, and I think over time this gap will eventually close,” Dr. Jetelina describes. “Parents just want to do the best thing for their kids and it takes time to be convincing.”

Some Vaccines Required For Schools

Every state is different but all states in the U.S. require at least some of the CDC-recommended vaccines for school entry—and they have done so long before COVID vaccines came on the scene. According to the Pew Research Center, all states require vaccines against diphtheria, tetanus,pertussis, polio, chickenpox, measles, and rubella. Every state besides Iowa also requires the mumps vaccine. Some daycares and preschools requireflu shots. Mandates for vaccines like hepatitis A and B also vary from state to state.

Not only do the CDC recommendations help schools decide what vaccines to require, but their recommendations have an important role to play when it comes to vaccine access for kids, Dr. Jetelina points out. CDC vaccine recommendations are added to the Vaccines for Children program, she says. When this happens, the federal government is required to pay for vaccines for children who don’t have health insurance.

“This is incredibly important for health equity in the United States,” Dr. Jetelina commented.