RSV
Sonya Collins
With RSV season well underway, pharmacists are navigating a more complex—and fragmented—guidance landscape. As CDC’s position as the sole authority on vaccine guidelines is called into question, other organizations are stepping up.
The major paradigm shift creates both confusion and opportunity.
“We’re trending toward more autonomy for the pharmacist,” said Jeff Goad, PharmD, from Chapman University School of Pharmacy in Irvine, CA. “More and more states have moved away from standing orders and protocols and given pharmacists more independent control over what resources to consult and when to vaccinate patients.”
CDC guidelines
CDC recommends a single dose of any FDA-licensed RSV vaccine for:
All adults aged 75 years and older.
Adults aged 50 to 74 years who are immunocompromised or have other conditions that increase risk of severe RSV disease.
To protect infants, CDC recommends either maternal vaccination between weeks 32 and 36 of pregnancy or infant immunization with RSV monoclonal antibodies.
Other organizations stepping up
Until recently, CDC’s role as the central arbiter of vaccine recommendations meant a single, unified guideline. The agency used transparent methods, such as the GRADE (grading of recommendations, assessment, development, and evaluation) and ETR (evidence to recommendation) approaches to arrive at vaccine guidelines.
“But CDC no longer uses that process,” Goad said. “We can’t determine if they’re using any process right now.”
Other medical bodies are now relying on their own evidence-review mechanisms.
The American Academy of Pediatrics, American Academy of Family Physicians, American College of Obstetricians and Gynecologists, and Infectious Diseases Society of America (IDSA) now offer their own—at times broader—recommendations.
IDSA, for example, recommends that vaccine administration for immunocompromised adults of any age should be guided by shared decision making. The organization also encourages vaccination for household members and close contacts of immunocompromised patients.
For the most part, the other organizations—except IDSA which is the outlier—are aligned with CDC, which says immunocompromised adults over 50 years should get the vaccine, Goad added. “Having CDC in the middle meant they could reconcile them, and we’d have one source for recommendations,” he said.
In addition to these societies, independent evaluators, such as University of Minnesota’s Vaccine Integrity Project and National Foundation for Infectious Diseases, are stepping in to fill the void left by changes at CDC. ■
A practical playbook for pharmacists
When recommendations conflict, how should pharmacists answer the question: “Should I get the vaccine?”
Start with state-level guidance
“This RSV season, we don’t automatically defer to CDC for recommendations,” said Jeff Goad, PharmD, from Chapman University School of Pharmacy in Irvine, CA. “In many states, CDC may now be listed as one potential source of recommendations among others.”
Some states are working on their own to streamline divergent recommendations, he added, “to make it more transparent and operational for vaccine providers, so they’re not left trying to figure out why one organization has this recommendation and another organization has that one.”
Several have formed regional alliances that will be aligned on guidelines for vaccines and other public health measures. The West Coast Health Alliance includes California, Oregon, Washington, and Hawai’i. The Northeast Public Health Collaborative brings together Connecticut, Maine, Massachusetts, New Jersey, New York State, Pennsylvania, Rhode Island, and New York City.
Err on the side of protection
If state guidance is unclear or nonexistent, defer to the organization whose guidelines offer the most coverage.
“We want to take the most liberal approach to make sure we’re not missing people who could benefit from the vaccine,” Goad said.
Discuss cost
Given the changing landscape of RSV vaccine recommendations, it may not be immediately clear whether insurance will cover the vaccine for certain patients.
America’s Health Insurance Plans said in a statement in September 2025 that plans would continue to cover all then–ACIP-recommended vaccines without cost-sharing for patients through the end of 2026.
“Pharmacists can run the claim to see if it will be covered,” Goad said. Out-of-pocket costs can then be a part of the discussion, he added, “talking to the patient about the risks and benefits, why they should get the vaccine, given the cost for a vaccine. That’s a decision, then, that the pharmacist and the patient can make together.”
Use your authority—and trusted resources
While the sea change at CDC may be unsettling, it could put more power in pharmacists’ hands. Pharmacists are increasingly empowered to make independent recommendations about vaccination as long as they base those recommendations on credible, authoritative sources.
For pharmacists, this is a moment of both challenge and opportunity. With the right approach—grounded in evidence, transparency, and shared decision making—they can help patients navigate a shifting landscape and access potentially lifesaving vaccines for RSV and beyond. ■