Centers for Disease Control and Prevention

National Center for Immunization and Respiratory Diseases

Photographs and images included in this presentation are licensed solely for CDC/NCIRD online and presentation 

use. No rights are implied or extended for use in printing or any use by other CDC CIOs or any external audiences.

COVID-19 Vaccine Policy and Next Steps

October 26, 2023

Megan Wallace, DrPH, MPH
COVID-19 Epidemiology
3

Trends in weighted variant proportion estimates and Nowcast –

United States, June 25 – October 14, 2023

PI=Prediction Interval

Source: https://covid.cdc.gov/covid-data-tracker/#variant-proportions
Weekly population-based rates of COVID-19-associated hospitalizations by 

season – COVID-NET, United States, March 2020–September 2023

Source: Coronavirus Disease 2019 (COVID-19) Hospitalization Surveillance Network (COVID-NET); https://www.cdc.gov/coronavirus/2019-

ncov/covidnetdashboard/de/powerbi/dashboard.html. Accessed October 16, 2023.

Oct Nov Dec Jan Feb Mar Apr May June July Aug Sep

Hospitalizations per 100,000

0

10

20

30

40

Surveillance Month

2020-2021

2019-2020

2021-2022

2022-2023

4
5

Weekly population-based rates of COVID-19-associated hospitalizations by 

age group – COVID-NET, United States, October 2022–September 2023

Source: Coronavirus Disease 2019 (COVID-19) Hospitalization Surveillance Network (COVID-NET); https://www.cdc.gov/coronavirus/2019-

ncov/covidnetdashboard/de/powerbi/dashboard.html. Accessed October 16, 2023.

Oct Nov Dec Jan Feb Mar Apr May June July Aug Sep

Surveillance Month

Hospitalizations per 100,000

0

10

20

30

60

50

40

5-17 years

0-4 years

18-49 years

50-64 years

≥65 years
6

Weekly COVID-19 new hospital admissions – National Healthcare Safety 

Network (NHSN), United States, August 2020 – September 2023

Source: COVID-19–associated hospitalization data reported to CDC’s National Healthcare Safety Network (NHSN). 

https://covid.cdc.gov/covid-data-tracker/#trends_weeklyhospitaladmissions_select_00
7

Weekly provisional COVID-19 deaths – National Vital Statistics System 

(NVSS), United States January 2020 – September 2023

Source: Provisional Deaths from the CDC’s National Center for Health Statistics (NCHS) National Vital Statistics System (NVSS). https://covid.cdc.gov/covid-data-tracker/#trends_weeklydeaths_weeklydeathrateaa_00 

Data during recent periods are incomplete because of the lag in time between when a death occurs and when a death certificate is completed, submitted to NCHS, and processed for reporting. This delay can range 

from 1 week to 8 weeks or more, depending on the jurisdiction. The most recent 3 weeks of mortality counts are shaded grey because NVSS reporting is <95% during this period.
COVID-19 Vaccine Policy
▪ ACIP met September 12, 2023 to review the available evidence for 

updated COVID-19 vaccines (monovalent, XBB.1.5 component)

▪ ACIP recommended updated COVID-19 vaccines as authorized under EUA 

or approved by BLA in persons aged ≥6 months

–Moderna COVID-19 vaccine in persons ≥6 months 

–Pfizer-BioNTech COVID-19 vaccine in persons ≥6 months 

–Novavax COVID-19 vaccine in persons ≥ 12 years

▪ All anticipated updated (2023–2024 Formula) vaccines are now 

authorized or approved

COVID-19 Vaccine Policy

9
▪ All doses should be homologous (i.e., from the same manufacturer) 

▪ All Moderna doses in ages 6 months – 11 years are now 25 μcg 

Recommendations for children aged 6 months – 4 years without

immunocompromise

Doses recommended:

▪ Initial series of 2 Moderna vaccine doses OR 3 PfizerBioNTech vaccine doses 

▪ Including at least 1 dose of 2023–2024 COVID-19 vaccine 

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Recommended 2023–2024 COVID-19 mRNA vaccines for people who are NOT 

immunocompromised, aged 6 months–4 years*†

*For information about administration intervals and children who transition from age 4 years to age 5 years, see Table 1 in the Interim Clinical Considerations for 

Use of COVID-19 Vaccines

† COVID-19 vaccination history refers to previous receipt of doses of Original monovalent mRNA or bivalent mRNA vaccine or a combination of the two; for people 

ages 12 years and older, Original monovalent Novavax COVID-19 Vaccine doses, alone or in combination with any mRNA vaccine doses; and for people ages 18 

years and older, Janssen COVID-19 Vaccine doses, alone or in combination with any mRNA or Original monovalent Novavax vaccine doses.

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▪ Exceptional situations: In the following exceptional situations, a different ageappropriate COVID-19 vaccine may be administered:

– Same vaccine not available

– Previous dose unknown

– Person would otherwise not complete the vaccination series

– Person starts but unable to complete a vaccination series with the same COVID-19 

vaccine due to a contraindication

▪ A Vaccine Adverse Event Reporting System (VAERS) report is not indicated for these 

exceptional situations.

Prior Version of Interim Clinical Considerations on 

Interchangeability of COVID-19 vaccines

Clinical Guidance for COVID-19 Vaccination | CDC 12
▪ COVID-19 vaccine doses from the same manufacturer should be administered 

whenever recommended. In the following circumstances, an age-appropriate COVID-19 

vaccine from a different manufacturer may be administered:

– Same vaccine not available at the vaccination site at the time of the clinic visit 

– Previous dose unknown

– Person would otherwise not receive a recommended vaccine dose

– Person starts but unable to complete a vaccination series with the same COVID-19 

vaccine due to a contraindication

▪ A Vaccine Adverse Event Reporting System (VAERS) report is not indicated in these 

circumstances.

Updated Version of Interim Clinical Considerations on 

Interchangeability of COVID-19 vaccines

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▪ Updated guidance for children who transition during the initial COVID-19 vaccination 

series from age 4 years to age 5 years and children who are moderately or severely 

immunocompromised and transition from age 11 years to age 12 years to receive the 

age-appropriate dosage based on their age on the day of vaccination

Additional Updates to Interim Clinical Considerations

Clinical Guidance for COVID-19 Vaccination | CDC 14
Recommendations for people aged 5 years and older without

immunocompromise 

Doses recommended:

• 1 dose of 2023–2024 COVID-19 vaccine

▪ mRNA COVID-19 vaccines authorized or approved for ages ≥6 months and Novavax COVID-19 vaccine 

authorized for ages ≥12 years 

▪ Unvaccinated persons receiving Novavax COVID-19 should complete a 2-dose initial series

▪ New harmonized age cutoff for recommendations for young children for Moderna and PfizerBioNTech COVID-19 vaccines resulting in simplified recommendations for 5-year-olds

▪ All Moderna doses in ages 6 months – 11 years are now 25 μcg 

▪ 2023–2024 COVID-19 vaccine dose is recommended at least 2 months after receipt of the last 

COVID-19 vaccine dose

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Recommended 2023–2024 COVID-19 mRNA vaccines for people who are NOT 

immunocompromised, aged 5–11 years*†

*For information about administration intervals and children who transition from age 4 years to age 5 years, see Table 1 in the Interim Clinical Considerations for 

Use of COVID-19 Vaccines

† COVID-19 vaccination history refers to previous receipt of doses of Original monovalent mRNA or bivalent mRNA vaccine or a combination of the two; for people 

ages 12 years and older, Original monovalent Novavax COVID-19 Vaccine doses, alone or in combination with any mRNA vaccine doses; and for people ages 18 

years and older, Janssen COVID-19 Vaccine doses, alone or in combination with any mRNA or Original monovalent Novavax vaccine doses.

16
Recommended COVID-19 vaccination schedule for people who are NOT moderately or 

severely immunocompromised, aged ≥12 years*†

*For information about administration intervals and children who transition from age 4 years to age 5 years, see Table 1 in the Interim Clinical Considerations for 

Use of COVID-19 Vaccines

† COVID-19 vaccination history refers to previous receipt of doses of Original monovalent mRNA or bivalent mRNA vaccine or a combination of the two; for people 

ages 12 years and older, Original monovalent Novavax COVID-19 Vaccine doses, alone or in combination with any mRNA vaccine doses; and for people ages 18 

years and older, Janssen COVID-19 Vaccine doses, alone or in combination with any mRNA or Original monovalent Novavax vaccine doses. 17
Recommendations for people aged ≥6 months who are 

moderately or severely immunocompromised

Doses recommended:

▪ Initial COVID-19 vaccine series*

▪ At least 1 2023–2024 COVID-19 vaccine dose

▪ May receive 1 or more additional 2023-2024 

COVID-19 vaccine doses**

*Series of 3 homologous mRNA COVID-19 vaccine doses or 2 homologous Novavax COVID-19 vaccine doses 

at time of initial vaccination. This could also include a history of receipt of 1 or more doses of Novavax or 

Janssen, including in combination with mRNA vaccine dose(s). 

**Further additional dose(s) may be administered, informed by the clinical judgement of a healthcare 

provider and personal preference and circumstances. Further additional doses should be administered at 

least 2 months after the last 2023-2024 COVID-19 vaccine dose. 

18
Recommended 2023–2024 COVID-19 vaccines for people who ARE moderately or severely 

immunocompromised, aged 6 months–4 years*†

* For information about administration intervals and children who transition from age 4 years to age 5 years or age 11 years to age 12 years during an mRNA 

vaccination series, and administration of additional dose(s), see Table 2 in the Interim Clinical Considerations for Use of COVID-19 Vaccines

† COVID-19 vaccination history refers to previous receipt of doses of Original monovalent mRNA or bivalent mRNA vaccine or a combination of the two; for 

people ages 12 years and older, Original monovalent Novavax COVID-19 Vaccine doses, alone or in combination with any mRNA vaccine doses; and for people 

ages 18 years and older, Janssen COVID-19 Vaccine doses, alone or in combination with any mRNA or Original monovalent Novavax vaccine doses. 19
Recommended 2023–2024 COVID-19 vaccines for people who ARE moderately or severely 

immunocompromised, aged 5–11 years*†

* For information about administration intervals and children who transition from age 4 years to age 5 years or age 11 years to age 12 years during an mRNA 

vaccination series, and administration of additional dose(s), see Table 2 in the Interim Clinical Considerations for Use of COVID-19 Vaccines

† COVID-19 vaccination history refers to previous receipt of doses of Original monovalent mRNA or bivalent mRNA vaccine or a combination of the two; for 

people ages 12 years and older, Original monovalent Novavax COVID-19 Vaccine doses, alone or in combination with any mRNA vaccine doses; and for people 

ages 18 years and older, Janssen COVID-19 Vaccine doses, alone or in combination with any mRNA or Original monovalent Novavax vaccine doses. 20
Recommended COVID-19 vaccination schedule for people who ARE moderately or 

severely immunocompromised, aged ≥12 years*†

* For information about administration intervals and children who transition from age 4 years to age 5 years or age 11 years to age 12 years during an mRNA 

vaccination series, and administration of additional dose(s), see Table 2 in the Interim Clinical Considerations for Use of COVID-19 Vaccines

† COVID-19 vaccination history refers to previous receipt of doses of Original monovalent mRNA or bivalent mRNA vaccine or a combination of the two; for 

people ages 12 years and older, Original monovalent Novavax COVID-19 Vaccine doses, alone or in combination with any mRNA vaccine doses; and for people 

ages 18 years and older, Janssen COVID-19 Vaccine doses, alone or in combination with any mRNA or Original monovalent Novavax vaccine doses. 21
▪ Consideration of additional COVID-19 vaccine doses in older adults

– Anticipated for February 2024 ACIP meeting

– Policy discussion will occur prior to individuals reaching 6 months since their last dose

▪ Preparations for future COVID-19 vaccine formula updates

– Discussions will begin at June 2024 ACIP meeting 

▪ Continue to monitor vaccine effectiveness, vaccine safety, and COVID-19 epidemiology

– COVID-19 vaccine recommendations can be updated if needed

Upcoming COVID-19 policy discussions

22
Acknowledgements

23

▪ Monica Godfrey

▪ Danielle Moulia

▪ Katherine Fleming-Dutra

▪ Ruth Link-Gelles

▪ Sarah Meyer

▪ Elisha Hall

▪ Susan Goldstein

▪ Mary Chamberland

▪ JoEllen Wolicki

▪ Natalie Thornburg

▪ Sierra Scarbrough

▪ Aron Hall

▪ Christopher Taylor

▪ Fiona Havers 

▪ Dave Wentworth

▪ Meredith McMorrow

▪ COVID-NET Team

▪ Coronavirus and other Respiratory Viruses Division

▪ National Center for Immunization and Respiratory 

Diseases
For more information, contact CDC

1-800-CDC-INFO (232-4636)

TTY: 1-888-232-6348 www.cdc.gov

The findings and conclusions in this report are those of the authors and do not necessarily represent the official 

position of the Centers for Disease Control and Prevention.

Photographs and images included in this presentation are licensed solely for CDC/NCIRD online and presentation 

use. No rights are implied or extended for use in printing or any use by other CDC CIOs or any external audiences.