Dear Local Health Departments,
On Oct. 6, 2025, the Acting CDC Director approved the Advisory Committee on Immunization Practices (ACIP) COVID-19 vaccine recommendations. The CDC has updated its adult and child immunization schedules to apply individual-based decision-making to COVID-19 vaccination for 6 months and older, after consultation with a health care provider.
In addition, based on this approval, individuals 7 years of age or older can receive a COVID-19 vaccine at a pharmacy without a prescription in accordance with the ACIP recommendations. As a result, NCDHHS will rescind the current State Health Director’s standing orders for COVID-19 vaccines on Monday, Oct. 13, 2025, to allow NC pharmacies time to adopt protocols that align with the approved ACIP/CDC recommendations.
Key points shared with VFC providers Monday are below.
- Since the approval of the 2025-2026 COVID-19 vaccines, any remaining 2024-2025 doses on hand are no longer authorized/recommended. They must be immediately removed from storage, recorded in NCIR as wasted, and returned per routine NCIP vaccine wastage guidelines. Providers should choose “Recall” as the wastage reason. Administration of non-authorized products is considered a vaccine administration error and must be reported to VAERS.
- CDC revised the COVID-19 vaccine recommendations for the Child, Adolescent, and Adult Immunization Schedules on Oct. 7, 2025.
- 2025 VFC provider stock: VFC providers are no longer required to routinely stock COVID-19 vaccines but must refer VFC-eligible children to a safety net provider (e.g., Local Health Department) if needed. LHDs should maintain a minimum VFC stock to support referrals.
- Due to uncertain demand of the COVID-19 vaccine, providers will not be penalized for expired or outdated 2025-2026 vaccines.
- Only NCIP providers can order the 2025-2026 COVID-19 vaccines for their VFC eligible populations through NCIR.
- The NCIP is unable to offer 317 VFA 2025-2026 COVID-19 vaccines this season.
Providers are encouraged to review the NCDHHS COVID-19 web page and talk with their patients about protecting them from COVID-19.
Professional medical societies recommend COVID-19 vaccination (PDF) for all children 6-23 months of age, children 2-18 years of age with a risk factors for severe illness or whose parents would like to have their child vaccinated, and all adults, especially those with risk factors or who have never received a vaccine. Vaccination is especially important for people at higher risk of severe disease, including pregnant women. Also see recommendations from the American Academy of Family Physicians, American Academy of Pediatrics, and American College of Obstetricians and Gynecologists.
Update on Standing Order templates:
DPH nursing leadership is completing the following guidance:
- Template policy/protocol/ standardized guidance for LHD licensed nurses to administer FDA-approved medications for "off-label" use (NCBON recommends agencies have policies r/t off-label use of medications).
- Sample (and annotated) standing order for administration of mNEXspike (COVID-19 Vaccine, mRNA) following ACIP guidance.
- Template guidance for Shared Clinical Decision Making (SCDM) by nurses.
How to contact us:
For assistance, please contact the NCIP Help Desk by phone at 1.877.USE.NCIR (1-877-873-6247) or by email.
Thank you for your ongoing partnership and dedication to improving immunization outcomes in North Carolina.
In Health,
NC Department of Health and Human Services