As fall approaches, local efforts to get residents vaccinated against flu and COVID-19 have been frustrated by a landscape of shifting federal guidance and dueling recommendations from state officials.
Under the leadership of Health Secretary Robert F. Kennedy Jr., the U.S. Food and Drug Administration and Centers for Disease Control have shifted who they recommend receiving some vaccinations. State leaders, in response, have taken the novel step to issue their own, distinct guidance.
Locally, health leaders have said that those changes in guidance have prompted confusion and reduced trust among residents, which could have a detrimental effect on how many people receive vaccinations against COVID-19 and other respiratory diseases this season.
The federal vaccine landscape has greatly shifted under the leadership of Kennedy, who has long voiced skepticism and unsubstantiated claims about vaccine efficacy.
In August, the FDA approved updated 2025-2026 COVID-19 vaccines for anyone 65 years or older, or for any person 6 months or older with an underlying health condition that could increase their risk or a severe COVID-19 infection.
The new policy is a shift from former recommendations and means that anyone not in those categories may face additional barriers in accessing the vaccine or may not have the vaccine covered by their insurance.
It follows previous steps from Kennedy that have shaken up the vaccine landscape in the United States.
In May, he announced that the CDC would no longer recommend COVID-19 shots for healthy pregnant women and children. It was a choice made, apparently, without the usual input from independent advisors and raised concerns among health experts outside of the administration.
In June, Kennedy fired all the members of the Advisory Council on Immunization Practices, the panel that provides recommendations on vaccines to the CDC and votes on updates to the country’s vaccine schedule. Two days after removing all 17 members, he announced a group of eight new members, some of whom are vaccine skeptics.
Local health leaders have called the shifts political, to the detriment of health care.
“I don’t think that health care is a political conversation. We know that there are people who have significant training and education around this who have supported the use of these vaccinations for a long time,” said Dr. Monica Vohra, chief medical officer at DotHouse Health. “I think it’s really important that we take this particular topic outside of politics and focus on the importance of what it’s done in the past and what it can do in the future in ensuring that we remain healthy.”
State-level officials have pushed back on the most recent federal changes. On Sept. 4, Gov. Maura Healey announced state-level steps to attempt to continue access to the shots.
Those efforts included directing the state’s Division of Insurance and Department of Public Health to require insurance carriers in the state to continue to cover vaccines recommended by the state’s Department of Public Health, becoming the first state to do so.
A separate standing order from the Department of Public Health allowed pharmacies to continue to provide COVID-19 vaccines to Massachusetts residents 5-years-old and above.
The Massachusetts Department of Public Health is expected to issue further specific vaccine guidance on vaccine recommendations by the end of September.
The state also announced plans to try to create a public health collaboration in New England and across the northeast to develop “evidence-based” recommendations.
A similar collaboration was announced by California, Oregon and Washington, Sept. 3.
In Boston, the state’s pushback has trickled down to the local level. Dr. Bisola Ojikutu, head of the Boston Public Health Commission, said that the city will follow the state guidance, as well as guidance from medical experts such as the American Academy of Pediatrics.
On Aug. 19, that organization recommended that all infants between the ages of six months and two years receive the updated vaccine and that children two through 18 years old should be offered the shot. The updated FDA guidance limited its approved guidance to anyone over the age of 65, or people six months and older with an underlying health condition.
Despite the dueling state and federal guidance, staff at local community health centers said they intend to stay the course and continue providing access to the vaccines they know can help protect community members.
“Bottom line: Codman knows vaccines work. Codman knows vaccines are important for protecting our community,” said Dr. Renee Crichlow, chief medical officer at Codman Square Health Center. “We are continuing to work on evidence-based public health.”
Vohra, too, said that DotHouse Health stands “firmly with evidence-based vaccines that support the health of individuals, families and the community.”
For the city, as well, efforts to provide access to COVID-19 vaccines will go on. Throughout the respiratory virus season, the Boston Public Health Commission regularly schedules free vaccine clinics across the city, and on that front the city will continue “full steam ahead,” Ojikutu said.
“We will do as much as we can to make sure that people have access to vaccination,” she said.
Already, the health commission has a handful of the clinics planned in Mattapan and Roxbury as well as at Boston City Hall, through the end of October.
Ojikutu said that they will schedule more based on community response, with a focus on communities that have historically faced health disparities.
For community health centers, part of the effort to support community vaccination is centered around continued education and communication to push back on any confusion caused by the landscape of shifting recommendations.
Alex Jean-Baptiste, Codman Square’s chief nursing officer, said that’s a matter of clear communication around what protection vaccines bring, what side effects they might present and a willingness to answer questions patients might have. He described his nursing team’s role as one of trying to talk with patients to “eliminate the fear.”
“There’s a lot of fear around, ‘If I take this vaccine, or if I take this medication, is going to change something?’” Jean-Baptiste said. “We’re here to help disseminate information, to help support them, to identify that, yes, you might have taken this and you’ll have muscle soreness tomorrow — that doesn’t mean that it didn’t work, or that you now have a new disease because of this.”
The response also pulls on lessons that health providers learned during the COVID-19 pandemic, when the vaccines were brand new and there was no shortage of concern going around about the new vaccines and the speed at which they were developed.
For example, Crichlow pointed to bringing information to where patients are in order to address concerns — not waiting for them to come to a health center — or to lean on the trust that medical professionals at facilities like community health centers have.
During the pandemic, that meant publicly getting the shot to show that it was trusted and safe. She said that, recently, she was approached by a woman at the Codman Square Health Center who told her that she got her entire family vaccinated because staff at the health center showed her that they were doing it too.
Now, Crichlow said, it means leveraging that same trust to remind patients that it’s still safe and beneficial to get the vaccine.
Relying on that trust is especially important given the timing of the changes around vaccine guidance. Local health experts said the fact that these dueling recommendations are coming at the start of fall, when rates or respiratory viruses like COVID-19 and flu tend to rise, adds another layer to the puzzle.
“This happening at this very time is complicated,” Vohra said. “Had it happened a few months ago, I think we would have been much more prepared to go into the respiratory season with everything that we needed to know.”
At DotHouse Health, it has meant delays in obtaining doses of the vaccines as the center tries to toe the line between wanting to provide evidence-based care to patients and maintaining status as a federally qualified center.
“This is the main vulnerability right now, in terms of particularly COVID-19, but also just all respiratory viruses,” Ojikutu said. “When you put information out there that makes individuals question a vaccine, that is obviously going to make them less likely to be vaccinated.”
She said she worries that more misinformation and disinformation around vaccines is likely to lead to reduced vaccination that could, in turn, increase the load in hospitals and emergency departments.
Ojikutu said that the health commission is in conversation with clinical providers about what those impacts might look like, but much of the specific planning around a response to potentially higher hospitalizations will hinge on how the next few months play out.
In the meantime, the city is looking to limit any major upticks in how many people end up hospitalized due to respiratory viruses by encouraging vaccination now.
“Vaccination is really one of the most effective and successful public health interventions that we have in our world,” Ojikutu said. “If you just look at the data, millions of lives have been saved by vaccination. We need to make sure that people realize that vaccination is effective, vaccination is successful, vaccination is safe and ensure that they do get vaccinated.”
Boston Public Health Commission is offering free flu and COVID-19 vaccinations at the following city-run vaccine clinics:
- Thursday, September 25, 2025, 3 – 8 p.m. at IFSI, 1626 Blue Hill Ave., Mattapan
- Thursday, October 16, 2025, 9 a.m. – 1 p.m. at Boston City Hall
- Saturday, October 18, 2025, 10 a.m. – 2 p.m. at Reggie Lewis Track and Athletic Center 1350 Tremont St., Boston
- Monday, October 27, 2025, from 1 to 5 p.m. at Boston City Hall
For more information, call the Mayor’s Health Line at 617-534-5050.
