Five years after the pandemic began, guidance around COVID-19 vaccination continues to evolve.
On August 27, 2025, the Food and Drug Administration (FDA) approved new versions of the shots, but in a move the American Academy of Pediatrics (AAP) calls "deeply troubling," imposed limits on who can get immunized against the virus.
As the Associated Press reports, the FDA approved updated vaccine formulas to protect against the latest strains of COVID-19. However, the only group of people who will get full access to the Pfizer, Moderna, and Novavax versions of the shots is seniors over 65.
Meanwhile, adults and kids must have one high-risk health condition, like obesity or asthma, to get across-the-board access to the vaccines through their insurance.
With the emergency authorization for kids under age 5 having expired, small children are also excluded from Pfizer's vaccination requirements. Moderna's version of the vaccine for children at least 6 months of age still has FDA approval.
Given that the vaccines may be available for fewer kids (and their caregivers), some are worried that if they want their child to be vaccinated, they will have trouble finding a doctor or pharmacist willing to administer the shots -- and that the vaccines will be too expensive, especially for low-income families.
The AAP has gone so far as to speak out against the FDA decision in light of these concerns.
Following the release of the FDA's guidelines, the AAP shared a statement that expressed clear concern, calling the decision to limit vaccination "deeply troubling."
"The American Academy of Pediatrics remains focused on increasing access to vaccines for all children, in all communities," Susan J. Kressly, MD, FAAP, president of the American Academy of Pediatrics, says in part in the statement.
"As we enter respiratory virus season, any barrier to COVID-19 vaccination creates a dangerous vulnerability for children and their families," she went on to say, explaining that respiratory infections can be especially risky for infants and toddlers, with their airways and lungs still developing.
The AAP recommends the vaccine for all kids from ages 6 to 23 months.
"Beyond age 2, we recommend annual shots for children and teens with health conditions that make COVID-19 especially risky," the statement says, also advising parents to talk to their pediatrician to make the best choice for their kids.
It's already overwhelming as a parent to deal with fears over your child getting sick. Now, with the varying guidance about the COVID-19 vaccine this year, many of us are struggling with how to proceed -- and what choices we even have.
Ari Brown, MD, an Austin, Texas-based pediatrician and founder of the Baby 411 book series and parent education, underscores the importance of the AAP's advice to vaccinate children between 6 and 23 months of age, and all kids with certain health conditions that put them at high risk for infection.
"The AAP has been offering trusted guidance for pediatric healthcare for over 90 years and has been creating immunization guidelines that entire time," she says.
But as Dr. Brown also acknowledges, "With the new FDA labelling, it may limit access to the vaccines."
For now, Dr. Brown tells Parents that it's unclear what will be available and where. As she notes, we don't yet know if pharmacies will be able to administer the vaccine "off-label" in certain states, or to what extent doctors will have the ability to purchase vaccine to stock it in their offices. Furthermore, what exactly will be covered by insurance remains equally hazy at this early stage.
"It will be clearer in the next few weeks as the new shipment of vaccine arrives and insurance companies decide on how to manage this situation," Dr. Brown says.
Cherokee Layson-Wolf, PharmD, BCACP, FAPhA, from the Department of Practice, Sciences, and Health Outcomes Research at the University of Maryland School of Pharmacy (UMSOP), says access in pharmacies may vary depending on state regulations.
She agrees that insurance coverage challenges won't be teased out until vaccines arrive and are given.
Another unknown? How the newest limits on who has access will impact the population at large, with Layson-Wolf, who is also waiting for the CDC's Advisory Committee on Immunization Practices (ACIP) to respond, cautioning, "If vaccination rates drop, we could see COVID-19 cases rise, making kids, parents, and caregivers at more risk for COVID-19."
Ultimately, experts agree that parents should talk to their child's health care provider about vaccine availability and to determine what is right for their specific needs and situation.