Deciphering COVID-19 Vaccination Recommendations for Children.

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The Essential Role of Pharmacists in Pediatric COVID-19 Vaccination

Evidence shows that pharmacists played a key role in COVID-19 vaccines for patients of all ages, including children, during the peak of the pandemic. Specifically, in the first three years of the pandemic (12/2020 – 9/2023) pharmacists provided 13 – 57% of all pediatric COVID-19 vaccines.1 Although most children receive most of their vaccines at their doctor’s office, survey data suggests about 15% (especially teens and those in cities) obtain routine vaccines from pharmacies.2 The pharmacist is the most accessible healthcare provider, with 89% of American’s living within 5 miles of a pharmacy.3 Thus, pharmacies remain an essential access point for vaccines for children.

Making Sense of COVID-19 Vaccine Recommendations for Kids

In recent months, the rules for when one can and should recommend COVID-19 vaccines to children has become confusing. The Advisory Committee on Immunization Practices has voted and Centers for Disease Control and Prevention (CDC) have changed COVID-19 vaccine for those 6 months and older to a shared clinical decision recommendation.4 It is important that it remains recommended at least at this level, as this will allow it to be paid for by the VFC program.

Meanwhile, the American Academy of Pediatrics (AAP) has made a stronger statement clearly recommending the COVID-19 vaccine for all infants and children 6 months through 23 months of age, as well as those 2 through 18 years old who: are unvaccinated, are at high risk of severe COVID-19 disease, live in congregate settings, have household members at high risk of severe COVID-19 disease, or whose parent/guardian wishes to provide them with additional protection.5

It is important to note, although confusing, these vaccine recommendations are not in conflict but rather differ in emphasis. The AAP guidance more clearly states which children are at highest risk and should be recommended to receive the vaccine while the CDC allows for individual decision-making. Notably, the CDC report shows that children < 2 years of age are at one of the highest risks of being hospitalized from COVID-19 disease, second only to those > 75 years old.6 As such, it is clear why this age is a routine recommendation, per the AAP. The AAP provides clear evidence for each of their recommendations in their COVID-19 specific recommendations.7

Which Pediatric Patients are Pharmacists Authorized to Vaccinate Against COVID-19 in 2025-26?

Which of our pediatric patients can we as pharmacists provide the COVID-19 vaccine to?  That partially depends on which state one is practicing.  The 12th PREP Act extension allows pharmacists in every state to continue to provide COVID-19 and flu vaccines down to 3 years of age, in accordance with ACIP/CDC recommendations.8  Beyond this federal authorization, vaccine administration regulations revert to each state’s law.  We published an updated chart with links in a recent JPPT article to help clarify these requirements and provide you with quick access to state-specifics.9

References

  1. El Kalach R, Jones-Jack NH, Grabenstein JD, et al. Pharmacists’ answer to the COVID-19 pandemic: Contribution of the Federal Retail Pharmacy Program to COVID-19 vaccination across sociodemographic characteristics-United States. J Am Pharm Assoc (2003). 2025;65(1):102305
  2. Kang Y, Zhang F, Vogt TM. Where do children get vaccinated in the U.S.? Parental experiences, attitudes, and beliefs about place of vaccination with a focus on pharmacies and schools. 2025;62:126801
  3. Berenbrok LA, Tang S, Gabriel N, et al. Access to community pharmacies: A nationwide geographic information systems cross-sectional analysis. J Am Pharm Assoc (2003). 2022;62(6):1816–1822.e2
  4. Centers for Disease Control and Prevention. Child and Adolescent Immunization Schedule by Age (Addendum updated August 7, 2025). Accessed September 20, 2025https://www.cdc.gov/vaccines/hcp/imz-schedules/child-adolescent-age.html
  5. American Academy of Pediatrics, Committee on Infectious Diseases. Red Book : Report of the Committee on Infectious Diseases 2024 – 2027. AAP Immunization Schedule. Accessed September 20, 2025https://publications.aap.org/redbook/resources/15585
  6. Centers of Disease and Prevention. Updates to COVID-19 epidemiology. 2025. https://www.cdc.gov/acip/downloads/slides-2025-09-18-19/02-Srinivasan-covid-508.pdf
  7. Committee on Infectious Diseases. Recommendations for COVID-19 Vaccines in Infants, Children, and Adolescents: Policy Statement. 2025
  8. Health and Human Services Department. 12th Amendment to Declaration Under the Public Readiness and Emergency Preparedness Act for Medical Countermeasures Against COVID-19. 2024;89(238):99875–99883. https://www.federalregister.gov/documents/2024/12/11/2024-29108/12th-amendment-to-declaration-under-the-public-readiness-and-emergency-preparedness-act-for-medical#:~:text=The%20Public%20Readiness%20and%20Emergency%20Preparedness%20(PREP)%20Act%20authorizes%20the,relating%20to%2C%20or%20resulting%20from
  9. Girotto JE, Warminski S, Oz T, Fly JH. Continuing as Partners in Immunization: Updates to Practice and Legislation for Pediatric Pharmacy Immunizations. J Pediatr Pharmacol Ther. 2025;30(5):691–695