The landscape of immunization recommendations is becoming increasingly fractured and fragmented, upending longstanding practices (see previous post, When Vaccine Guidelines Shift, Collaboration is Key). The recent publication of COVID-19 recommendations from the American Academy of Pediatrics (AAP) reflect an inflection point, with significant divergence in recommendations from different public health authorities, raising key questions for public health, healthcare providers, and the open source Immunization Calculation Engine (ICE) project.
In May, the CDC, under the directive of the HHS Director, downgraded COVID-19 recommendations among healthy children aged 6 months through 17 years from “routine” to “shared clinical decision making” and removed recommendations for pregnant women to receive the vaccine. As a result, several medical societies and associations are suing the administration for violating established procedures in making these changes.
Additionally, the AAP recently published an immunization schedule reflecting different COVID-19 guidelines for the 2025-2026 season. The AAP recommends routine COVID-19 vaccination for all patients aged 6 through 23 months and indicates COVID-19 vaccine should be offered to healthy children aged 2 through 18 years if the parent/guardian desires protection.
This fall, a re-constituted Advisory Committee on Immunization Practices (ACIP) is expected to discuss COVID-19 recommendations, which may prompt further changes to the CDC recommendations.
As we consider what this means for the Immunization Calculation Engine (ICE), key questions include:
- What additional organizations may be issuing immunization recommendations?
- How should we consider recommendations issued by different organizations in relation to maintaining the ICE Default Immunization Schedule?
- How should we navigate the potential desire for different immunization recommendations among ICE users? Should ICE support multiple schedules?
As an open source project, we look forward to collaborating with our users as well as immunization stakeholders to help chart the path ahead. We are committed to continued transparency on the specification-level logic for the immunization clinical decision support provided by ICE. We anticipate this logic, as published on the ICE Wiki, as well as the ICE software, will continue to serve as important resources, not only among ICE users but also the broader immunization community in understanding shifting guidelines.
For more information on ICE, or to get involved in this effort, please reach out to us at ice@hln.com.