Changes with 2025-2026 COVID-19 vaccines are causing confusion.
Who should be vaccinated? Continue to discuss COVID-19 vaccination for patients ages 6 months and up.
Be aware that FDA labels for 2025-2026 COVID-19 vaccines limit use to ages 65 and up...and younger patients at high risk.
But now ACIP has voted to recommend shared clinical decision-making for all patients 6 months and older.
It comes on the heels of numerous medical organizations publishing their own scientific recs...and advocating against limiting access.
For instance, Am Acad of Pediatrics recommends COVID-19 vaccines for all kids 6 to 23 mos, and those 2 to 18 yr at high risk or whose parent or caregiver chooses vaccination. Am Acad Family Physicians also recommends this for kids plus routine vaccination for adults. And American Coll of Obstetricians and Gynecologists still recommends vaccination in pregnancy.
Follow your state law, protocol, etc...or help get an Rx if needed. Learn more about your state’s requirements with Bula’s Immunizations FAQ.
Listen with empathy to concerns...and help weigh benefits and risks.
Explain MANY patients have a risk factor for severe illness from COVID-19 infection...diabetes, heart or lung disease, obesity, depression, smoking, pregnancy, immunocompromise, etc.
But data show COVID-19 vaccination reduces risk of long COVID, hospitalization, death, adverse pregnancy outcomes from COVID-19, etc.
And despite stronger heart warnings for mRNA COVID-19 vaccines, myocarditis is still rare...about 27 cases per million doses in males 12 to 24 years...and less common and severe than with COVID-19 infection.
Anticipate that most payers will cover COVID-19 vaccination.
Which vaccine should be used? All 2025-2026 COVID-19 vaccines will be monovalent. mRNA options (Comirnaty, Spikevax, mNexspike) preferentially target LP.8.1...protein-based Nuvaxovid targets JN.1.
Administer any age-appropriate option. For patients 65 years and older, use any product...Comirnaty (Pfizer-BioNTech), Spikevax (Moderna), new mNexspike (Moderna), or Nuvaxovid (Novavax).
But for younger patients, it varies. Spikevax can be used starting at 6 months...Comirnaty at 5 years...and mNexspike or Nuvaxovid at age 12.
Take note of other differences. For instance, mNexspike targets specific parts of the SARS-CoV-2 spike protein...so it’s a lower dose (10 mcg/0.2 mL) than Spikevax (50 mcg/0.5 mL).
mNexspike is also being promoted as more effective...especially for ages 65+. But the number needed to vaccinate in this group to prevent one more COVID-19 case is 73 people. And mNexspike costs about $35 more/dose.
Advise that combo flu/COVID-19 vaccines won’t be available this fall...and that it’s okay to get the separate vaccines at the same visit.
See our COVID-19 Vaccines 2025-26 resource for dosing, storage, etc...plus answers to FAQs about safety and effectiveness.
- American College of Obstetricians and Gynecologists. Practice Advisory. COVID-19 vaccination considerations for obstetric-gynecologic care. December 2020. Updated August 2025. https://www.acog.org/clinical/clinical-guidance/practice-advisory/articles/2020/12/covid-19-vaccination-considerations-for-obstetric-gynecologic-care (Accessed August 28, 2025).
- American Academy of Pediatrics. AAP, medical societies creating flu, RSV, COVID-19 vaccine guidance for fall. July 25, 2025. https://publications.aap.org/aapnews/news/32715 (Accessed August 12, 2025).
- CDC. COVID-19. People with Certain Medical Conditions and COVID-19 Risk Factors. June 11, 2025. https://www.cdc.gov/covid/risk-factors/index.html (Accessed August 12, 2025).
- FDA. FDA approves required updated warning in labeling of mRNA COVID-19 vaccines regarding myocarditis and pericarditis following vaccination. June 25, 2025. https://www.fda.gov/vaccines-blood-biologics/safety-availability-biologics/fda-approves-required-updated-warning-labeling-mrna-covid-19-vaccines-regarding-myocarditis-and (Accessed July 24, 2025).
- Medication pricing by Elsevier, accessed September 2025.