Vaccine Integrity Project, American Medical Association review COVID, flu, and RSV vaccines
Meghan HolohanToday at 10:42 a.m.
Vaccine Integrity Project
Adult (non-flu) Vaccines
COVID-19
Influenza Vaccines
Respiratory Syncytial Virus (RSV)
Fall brings many new changes, including a new school year and a surge of respiratory illnesses. With little direction from the federal government, many people are confused about whether they need a flu, COVID-19, or respiratory syncytial virus (RSV) vaccine.
To fill the information void, the Vaccine Integrity Project (VIP) at the University of Minnesota’s Center for Infectious Disease Research and Policy (CIDRAP, publisher of CIDRAP News), and the American Medical Association (AMA) published the results of their independent evidence review of the influenza, COVID-19, and RSV vaccines today in JAMA.
Filling in gaps left by federal vaccine-process breakdown
“We are living in unprecedented times when it comes to modern vaccine review and recommendation,” said Michael Osterholm, PhD, MPH, CIDRAP director and coauthor of an accompanying commentary. “The VIP program will never replace ACIP [Advisory Committee on Immunization Practices]. In the interim, it’s the stopgap measure that allows us to continue recommending these vaccines based on a comprehensive review of both effectiveness and safety.”During a press briefing yesterday on the evidence reviews, four of the country’s major medical organizations—the American Academy of Family Physicians (AAFP), the American Academy of Pediatrics (AAP), the American College of Obstetricians and Gynecologists (ACOG), and the Infectious Diseases Society of America (IDSA)— provided their vaccine recommendations for the 2026-27 respiratory illness season.
“We cannot allow the breakdown of a federal process to create a vacuum in evidence-based vaccine guidance,” Bruce Gellin, MD, MPH, chair of the VIP Board of Advisors, said during the briefing.
“Americans are hearing conflicting messages about vaccines right now, and it’s understandable that people are asking whom they should trust,” he added. “I would encourage them to look at the process behind the development of these recommendations.”
What the science says
The VIP Evidence Review team, co-led by Nicole Basta, PhD, examined studies that reviewed all licensed or approved products in the United States designed to prevent COVID-19, flu, and RSV, with a focus on safety, effectiveness, and epidemiology.We cannot allow the breakdown of a federal process to create a vacuum in evidence-based vaccine guidance.
Bruce Gellin, MD, MPH
When it comes to the flu, the evidence shows that “influenza vaccines reduce the risk of severe disease,” said Basta.
Being vaccinated against flu cuts the risk of hospitalization in people ages 65 and older by 31%. Flu vaccination in pregnancy lessens the likelihood of symptomatic illness in infants from birth to 6 months by 44%, while vaccination in children ages 6 months to 17 years is associated with an 80% drop in deaths from flu, Basta said. The COVID-19 vaccine is linked to a lower risk of a hospital stay or death.
“The evidence that we reviewed supported the effectiveness of COVID-19 vaccines at reducing the risk of hospitalization and mortality for those at high risk of severe disease, including older adults, infants, and during pregnancy,” she said.
In adults 65 and older, COVID vaccination is tied to a 53% lower risk of hospitalization. The vaccine also cuts the rates of intensive care unit stays and death for people with weakened immune systems by 32% to 53%, based on the particular medical condition.
COVID vaccination during pregnancy slashes emergency department and urgent care visits by 58% and hospital visits for infants by 36% in their first year. Visits to pediatric emergency departments dropped 76% in vaccinated children aged 9 months to 4 years.
RSV vaccination protects older adults, pregnant women, and infants from serious illness or hospitalization, Basta said.
“RSV vaccination of older adults and during pregnancy, and infant immunization with monoclonal antibodies substantially reduced severe illness and hospitalization,” she said. “For adults 60 and older, multiple studies showed significant reductions in hospitalization with vaccine effectiveness, ranging from 69% to 83%.”
Women vaccinated while pregnant reduce their chances of RSV by 82% and also protect their infants from RSV-associated hospital stays. Infants who receive the monoclonal antibody nirsevimab (Beyfortus) have a 64% to 93% lower risk of hospitalization.
“More evidence is needed to determine if repeated or annual RSV vaccination is necessary,” Basta said. “Our review identified evidence gaps for this question.”
Individual organization recommendations
Each medical organization’s recommendations for vaccination vary slightly based on patient population. Physicians at each organization reviewed the VIP data to guide their advice for the upcoming respiratory illness season.Staying up to date on vaccines is one of the best ways to keep the country healthy.
Sarah C. Nosal, MD
The AAFP recommends:
- An updated COVID-19 vaccine for everyone older than 19 years
- A COVID-19 vaccine and a booster spread out over six months for those over 65
- An updated flu vaccine for everyone ages 6 months to 64 years
- An enhanced, adjuvanted, high-dose, or recombinant flu vaccine for people 65 and older
- An RSV vaccine for people ages 50 to 74 with high-risk conditions
- An RSV vaccine for everyone older than 75
- The RSV monoclonal antibody nirsevimab for all children younger than 8 months in their first RSV season, if their mother did not receive an RSV vaccine during pregnancy
- Nirsevimab for children 8 to 19 months at severe risk for disease in their second RSV season, regardless of the mother’s vaccination status
- A COVID-19 vaccine for all infants ages 6 to 23 months
- A COVID-19 vaccine for children ages 2 and older at risk for severe infection
- An annual flu vaccine for everyone older than 6 months
- A COVID-19 vaccine for everyone ages 6 months and older with a weakened immune system
- Discussion with a clinician about a COVID-19 booster dose two to six months after the first dose for people with high risk conditions
- An annual high-dose, adjuvanted, inactivated, or recombinant flu vaccine for patients with weakened immune systems
- The live attenuated flu vaccine isn’t recommended for people with suppressed immunity
- An RSV vaccine for adults with weakened immune systems
- An updated COVID-19 vaccine for women who are pregnant, considering pregnancy, or are breastfeeding
- An inactivated or recombinant flu vaccine for women who are pregnant or postpartum
- Either an RSV vaccine during pregnancy or administration of nirsevimab to a newborn
Every organization agrees that regular vaccination remains important.
“Physicians know that patients may have questions about vaccines and are ready to have conversations about why they are important and how they help protect you and your loved ones,” Sarah C. Nosal, MD, president of the AAFP board of directors, said in the press briefing. “Staying up to date on vaccines is one of the best ways to keep the country healthy.”