How CDC Is Making COVID-19 Vaccine Recommendations
When the U.S. Food and Drug Administration (FDA) authorizes or approves a COVID-19 vaccine, the Advisory Committee on Immunization Practices (ACIP) will quickly hold a public meeting to review all available data about that vaccine (sign up to receive email updates whenever ACIP’s Meeting Information is updated). ACIP is an independent panel of medical and public health experts. Before making recommendations, ACIP reviews all available clinical trial information, including descriptions of:
- Who received the vaccine (age, race, ethnicity, underlying medical conditions)
- How different groups responded to the vaccine
- What side effects people had
From these data, ACIP will then vote on whether to recommend the vaccine. While vaccine supplies were limited, ACIP also voted on recommendations for who should be offered COVID-19 vaccine first.
COVID-19 Vaccination Recommendations
- On Dec. 1, 2020, ACIP recommended that healthcare personnel and long-term care facility residents be offered COVID-19 vaccination first (Phase 1a).
- On Dec. 11, 2020, FDA issued the first Emergency Use Authorization (EUA) for use of the Pfizer-BioNTech COVID-19 Vaccineexternal icon in people aged 16 years and older, and on Dec. 13, 2020, ACIP issued recommendations for use of the Pfizer-BioNTech COVID-19 Vaccine for the prevention of COVID-19.
- On Dec. 18, 2020, FDA issued an EUA for use of the Moderna COVID-19 Vaccineexternal icon in people aged 18 years and older, and on Dec. 20, 2020, ACIP issued recommendations for use of the Moderna COVID-19 Vaccine for the prevention of COVID-19.
- On Dec. 20, 2020, ACIP updated interim vaccine allocation recommendations. In Phase 1b, COVID-19 vaccine should be offered to people aged 75 years and older and non–healthcare frontline essential workers, and in Phase 1c, to people aged 65–74 years, people aged 16–64 years with high-risk medical conditions, and essential workers not included in Phase 1b.
- On Feb. 27, 2021, FDA issued an EUA for the use of Johnson & Johnson’s Janssen (J&J/Janssen) COVID-19 Vaccineexternal icon in people aged 18 years and older, and on Mar. 2, 2021, ACIP issued recommendations for the use of the J&J/Janssen COVID-19 Vaccine for the prevention of COVID-19. On Apr. 30, 2021, ACIP updated recommendations for use of the J&J/Janssen COVID-19 Vaccine after reports of blood clots with low platelets (thrombosis with thrombocytopenia syndrome, TTS) among vaccine recipients.
- On May 10, 2021, FDA expanded the EUA for use of the Pfizer-BioNTech COVID-19 Vaccineexternal icon to include adolescents aged 12–15, and on May 12, 2021, ACIP issued recommendations for use of the Pfizer-BioNTech COVID-19 Vaccine among this population for the prevention of COVID-19.
- On Aug. 23, 2021, FDA approved the Pfizer-BioNTech (COMIRNATY) COVID-19 Vaccine for people aged 16 years and older.
- On Sept. 22, 2021, FDA amended the EUA for use of the Pfizer-BioNTech COVID-19 Vaccineexternal icon to include a booster shot at least 6 months after completing the primary Pfizer-BioNTech vaccine series for certain individuals aged 18 years and older.
- On Sept. 24, 2021, CDC recommended booster shots for certain populations at least 6 months after completing the primary Pfizer-BioNTech vaccine series.
Learn more about ACIP and CDC recommendations for COVID-19 vaccines.
ballot check light icon ACIP resources: Recommendation process, meeting agendas, minutes, live meetings, and presentation slides
ACIP identified four ethical principles to guide their decision-making process when supply was limited:
- Maximize benefits and minimize harms — Respect and care for people using the best available data to promote public health and minimize death and severe illness.
- Mitigate health inequities — Reduce health disparities in the burden of COVID-19 disease and death, and make sure everyone has the opportunity to be as healthy as possible.
- Promote justice — Treat affected groups, populations, and communities fairly. Remove unfair, unjust, and avoidable barriers to COVID-19 vaccination.
- Promote transparency — Make a decision that is clear, understandable, and open for review. Allow and seek public participation in the creation and review of the decision processes.
Learn more about ACIP’s Ethical Principles for Allocating Initial Supplies of COVID-19 Vaccine.
Input from the public and the following professional groups informed ACIP’s discussions on who should receive COVID-19 vaccines when supply was limited:
- Johns Hopkins Bloomberg School of Public Health: Interim Framework for COVID-19 Vaccine Allocation and Distribution in the United Statesexternal icon
- The National Academies of Sciences, Engineering, and Medicine: Framework for Equitable Allocation of COVID-19 Vaccineexternal icon
- World Health Organization (WHO) Strategic Advisory Group of Experts (SAGE): WHO SAGE Values Framework for the Allocation and Prioritization of COVID-19 Vaccinationpdf iconexternal icon
- WHO SAGE: WHO SAGE Roadmap for Prioritizing Uses of COVID-19 Vaccines in the Context of Limited Supplypdf iconexternal icon
Learn about CDC’s vaccine recommendation process.
Vaccine Rollout Recommendations
When the U.S. supply of COVID-19 vaccine was limited, CDC provided recommendations to federal, state, and local governments about who should be vaccinated first. CDC’s recommendations were based on those from ACIP.
The recommendations were made with these goals in mind:
- Decrease death and serious disease as much as possible.
- Preserve functioning of society.
- Reduce the extra burden COVID-19 had on people already facing disparities.
While CDC made recommendations for who should be offered COVID-19 vaccine first, each state had its own plan for who would be vaccinated first and how they could receive vaccines.
On May 12, 2021, vaccine eligibility expanded to everyone in the United States aged 12 years and older.