Each fall, nurses and doctors brace for an all-too-familiar seasonal surge. Patients struggle to breathe. Older adults lean forward, lips pursed as if trying to drink air through a straw. Infants take more than one shallow breath per second, their wide-eyed panic reflected in their parents’ faces. As an internist, I have cared for too many young, previously healthy patients laid low by infection, some requiring a breathing tube or other intensive care.
More than ever before, much of this suffering is avoidable, particularly because of immunizations for seasonal influenza, respiratory syncytial virus (RSV), and Covid-19.
But changes in federal vaccine guidance are creating confusion about who can get these shots and how. To best serve our patients, the rest of our nation’s health system needs to step up and clear the air on seasonal vaccines.
Just this week, the Food and Drug Administration narrowed the label for Covid-19 vaccines, restricting it to people over the age of 65 or those with listed high-risk conditions. While it may seem reasonable to focus on those at greatest risk, the FDA’s action places the United States out of step with peer countries such as Canada, Australia, Belgium, and Sweden, all of which recommend vaccination for higher-risk groups — but also allow anyone to receive updated Covid-19 vaccines, given their strong safety profile.
The change to the label is likely to affect Americans’ access, though the devil is in the details with respect to how. Despite well-established evidence that vaccines can help prevent illness and death from Covid-19, children and adults who don’t meet the new definition of “high risk” may have to search for a doctor willing to prescribe the vaccine off-label. The label change also means pharmacists, who administered about 90% of Covid-19 vaccines in past years, face new limits on their ability to provide vaccines, depending on their state’s laws.
Another worry is that the controversy and confusion over Covid-19 vaccines will decrease uptake of other respiratory virus vaccines. Flu and RSV immunizations remain broadly accessible, but we must ensure they actually reach the general public. This is a tall task each year, even when there is consistent guidance. For instance, a flu vaccine is recommended for everyone 6 months and older, but in 2024, slightly less than half of eligible children received one. That flu season, a particularly severe one, 275 children died due to influenza; 90% occurred in children who weren’t vaccinated.
I’ll never forget one of the first patients I ever took care of as a medical student, almost 20 years ago. An infant with RSV presented almost exactly as the textbook I had just read described: grunting breaths, flaring nostrils, and the skin between her tiny ribs sucking in due to her laboring lungs. My textbook also said that there wasn’t much we could do for her — no antiviral, no other medicine — other than oxygen and supporting her through the infection.
Today, we can prevent much of this type of suffering, because RSV vaccines administered to pregnant women confer months of protection to newborns, and monoclonal antibodies are very effective at preventing RSV among other infants. Yet less than 1 in 3 eligible children received — and thus benefited from — these immunizations in the first year they were offered.
At the other end of the age spectrum, an RSV vaccine is now recommended for those aged 50 to 74 at higher risk for severe disease, along with everyone 75 and older. Indeed, if the majority of older adults were immunized against RSV, influenza, and Covid-19, tens of thousands of hospitalizations would be averted each year — saving lives and money.
Reciprocally, keeping immunizations free for patients is an essential step in enabling access. Health insurance associations have already signaled a commitment to access and affordability, calling vaccine coverage “a top priority for protecting both individual and community health.” Individual health plans should clarify continued coverage and no copays to their members and clinicians, especially as vaccines are starting to hit the shelves this month — and especially as changes to Covid-19 labels might make some patients worried about their coverage.
These actions by health insurers are buttressed by clear, evidence-based vaccine guidelines from professional medical societies. Earlier in the summer, 80 leading medical societies reaffirmed their commitment to influenza, RSV, and Covid-19 vaccines as critical tools to protect against respiratory viruses. The American Academy of Pediatrics recently released its updated vaccine guidance, notably recommending Covid-19 vaccines to children at higher risk of severe disease, including all infants 6 to 23 months of age — diverging from federal recommendations for the first time in more than 90 years.
Communicating these recommendations is just as important as the independent scientific reviews professional societies have undertaken. As other organizations release their own recommendations in coming weeks, ensuring that there is a unified message about who should get which vaccines will require greater coordination across societies, public health, hospitals, pharmacies, and insurance companies. For instance, it may not be well understood that the list of “high risk” conditions referenced in the narrowed FDA label for Covid-19 vaccines still encompasses a broad swath of Americans. High-risk conditions include pregnancy and common diagnoses such as diabetes, cancer, a disability, being overweight, having a mental illness, or problems with the heart, lungs, liver, or kidney.
Leaders in state government can support patients who want vaccines (and their clinicians) by authorizing pharmacists, nurses, and other health care providers to keep administering Covid-19 vaccines without disruption from the FDA label change. For example, Colorado recently passed legislation to allow the state health department to consider immunization recommendations from medical specialty societies in addition to the federal government.
Beyond the confusion created by abrupt changes at the FDA and the broader regulatory landscape, misinformation continues to erode confidence in vaccines. Public health departments — already stretched thin by shrinking budgets — cannot counter it alone.
This moment calls for communication strategies grounded in “radical listening” to people’s concerns and responses that resonate. Often this is more about the messenger than the message. Deeper partnership with local clinicians and community-based organizations can help elevate trusted messengers, from religious leaders to community health workers.
Together, these practical actions can help the health sector navigate recent shifts to ensure patients can access vaccines easily and affordably, and communities can prevent severe illness, particularly for their most vulnerable. Seasonal surges of respiratory disease affect everyone because they strain emergency departments, delay routine medical procedures, and contribute to workforce shortages across the healthcare system. These impacts ripple into everyday life: missed school days for children, missed work for caregivers, and increased strain on community resources.
The throughline is simple: Vaccines must be easy to get, free at the point of care, and clearly recommended — for everyone who wants them.
By each winter’s end, influenza, RSV, and Covid-19 together claim more lives than all other infectious diseases combined. Yet we can avoid much of this tragedy. Now is the time to clear the air by ensuring common sense access to respiratory virus vaccines.
Dave A. Chokshi is a physician at Bellevue Hospital, professor at the City College of New York, and chair of the Common Health Coalition. Previously, he served as health commissioner of New York City.