Vaccines Access
ACIP Recommendation by Product and Age
| Product | Population | ACIP posture | Why it matters |
|---|---|---|---|
| Influenza (seasonal) | Everyone 6 months+ | Routine annual | Coverage benchmark. 2025-26 adult uptake 46.5% (NIS-FRVM). |
| COVID (seasonal) | Adults; narrower than pandemic | Seasonal; age and risk rules have tightened | Coverage 17.5% of adults 18+ in 2025-26. Recommendation design is the demand switch. |
| RSV vaccines (Arexvy, Abrysvo, mRESVIA) | 75+; 50-74 at increased risk | Single dose, not annual. No product preference. | The 2024 vote killed the annual-booster TAM. Arexvy fell from £1.238B (2023) to about £0.6B. |
| Beyfortus (nirsevimab) | Infants entering first RSV season | Routine infant prevention | Competes with maternal Abrysvo. Sanofi said Beyfortus was not hit by the 2026 childhood-schedule edit. |
| Enflonsia (clesrovimab) | Infants entering first RSV season | FDA approved Jun 2025; ACIP vote is in the stayed set | CRS notes the June 2025 infant-RSV vote may not currently sit on the CDC schedule. Coverage is unsettled. |
| Abrysvo (maternal) | Pregnancy, 32-36 weeks | Maternal indication | Only RSV vaccine with a pregnancy label. Not split out in Pfizer's product table. |
| Shingrix | Adults 50+ | Routine | IRA $0 Part D copay. US immunization 44%; ex-US is now 66% of GSK sales. |
| Prevnar family / Capvaxive / Vaxneuvance | Pediatric routine; adult pneumococcal by age and risk | Routine pediatric; adult share fight | VFC catalog is the public-sector price. Adult is pharmacy and Part D. |
| Gardasil 9 | 9-26 routine; 27-45 shared clinical decision | Routine through 26 | Shared decision-making is a coverage binary. China destock is a tender risk, not an ACIP risk. |
CDC Posted Immunization Schedule, July 2025
| Antigen | CDC posted posture | Ages on the posted tables | Roster P&L |
|---|---|---|---|
| Hepatitis B | Routine childhood series. Adult table: 2, 3, or 4 doses depending on vaccine | Birth dose, then 1 to 2 months and 6 to 18 months on the child table | HEPLISAV-B is the 2-dose adult product in the Sanofi-Dynavax deal. Pediatric HepB sits in combination books. |
| Rotavirus | Routine infant | 2 and 4 months (RV1) or 2, 4, and 6 months (RV5) | Merck RotaTeq $673M in 2025. GSK Rotarix is inside established and Gavi volume. |
| DTaP / Tdap | Routine childhood plus adolescent booster | DTaP on the infant table (2, 4, 6, 15 months). Tdap: 1 dose at 11 to 12 years (CDC child notes) | Sanofi PPH and GSK established. Not a single SKU P&L. |
| Hib | Routine infant | 2, 4, then 12 to 15 months (third or fourth dose per notes) | Inside Sanofi PPH. |
| Pneumococcal conjugate | Routine pediatric. Adult 50+ if never received a PCV (MMWR 2025 adult schedule) | Infant 2, 4, 6, and 12 to 15 months (PCV15 or PCV20) on the child table. Adult table: see notes; MMWR 2025: universal at 50+ if no prior PCV15/20/21 | Pfizer Prevnar family $6.494B. Merck Vaxneuvance and Capvaxive. |
| IPV | Routine childhood | 2, 4, 6 to 18 months, and 4 to 6 years | Inside Sanofi PPH. |
| Influenza | Routine annual from 6 months | 1 or 2 doses annually by age and prior doses. Adult 65+ prefers HD, recombinant, or adjuvanted | Sanofi flu/COVID bundle (unsplit). CSL Seqirus. GSK influenza £303M. |
| COVID-19 | Seasonal; see notes | Posted child and adult tables point to notes, not a fixed annual age band | Pfizer Comirnaty and Moderna Spikevax. Recommendation design is the demand switch. This row is the posted schedule, not uptake. |
| MMR and varicella | Routine two-dose | First dose 12 to 15 months. Second dose 4 to 6 years | Merck ProQuad / M-M-R II / Varivax $2.451B. |
| Hepatitis A | Routine childhood two-dose | 12 to 23 months | Tender and travel adjacency. Not a named 2025 franchise line here. |
| HPV | Routine adolescent; adult catch-up through 26; 27 to 45 shared clinical decision | CDC child notes: routinely recommended at 11 to 12 years (can start at 9); catch-up through 18. Adult table: 19 to 26 (2 or 3 doses); 27 to 45 shared clinical decision | Merck Gardasil. Shared decision-making is a coverage binary. |
| MenACWY | Routine adolescent two-dose | CDC child notes: 2-dose series at 11 to 12 years and 16 years | GSK Menveo / Penmenvy. Sanofi MenQuadfi sits inside the unsplit meningitis/travel/endemic bundle. |
| MenB | Shared clinical decision at 16 to 23, not a routine series | CDC child notes: healthy adolescents 16 to 23 (preferred 16 to 18), 2 doses 6 months apart based on shared clinical decision-making. Increased-risk: 3-dose series | GSK Bexsero. Shared decision is the demand switch, not a second COVID. |
| RSV infant (nirsevimab) | Routine infant prevention on the child table | 1 dose depending on maternal RSV vaccination status, with 8 to 19 months notes | Sanofi/AZ Beyfortus. Merck Enflonsia is FDA-approved; the June 2025 ACIP vote is in the stayed set and is not treated as coverage here. |
| RSV vaccine (Abrysvo, adults) | Maternal seasonal; adult 75+ and 50 to 74 at increased risk | Child table: seasonal in pregnancy. Adult table: 75+ and 50 to 74 (see notes). Single dose, not annual | Pfizer Abrysvo. GSK Arexvy and Moderna mRESVIA share the adult row. The 27 Apr 2026 adult-page amendment added the April 2025 RSV language as adopted by HHS. |
| Shingles (RZV) | Routine adult 50+ | 2 doses at 50 to 64 and 65+ | GSK Shingrix. No 2026 US commercial competitor. |
CDC VFC Catalog Prices, April 2026
| Product | Manufacturer | CDC cost / dose | Private sector / dose |
|---|---|---|---|
| Gardasil 9 | Merck | $275.01 | $328.24 |
| Prevnar 20 | Pfizer | $200.13 | $299.25 |
| Vaxneuvance | Merck | $184.19 | $239.87 |
| ProQuad | Merck | $194.95 | $286.17 |
| Vaxelis | Merck | $108.72 | $167.36 |
| Pentacel | Sanofi | $78.39 | $130.53 |
| Bexsero | GSK | $159.12 | $251.31 |
| MenQuadfi | Sanofi | $117.77 | $177.11 |
| Beyfortus 50mg / 100mg | Sanofi | $443.78 | $595.06 |
| Enflonsia | Merck | $422.04 | $556.00 |
| Abrysvo | Pfizer | $240.04 | $319.07 |
| Jynneos | Bavarian Nordic | $232.71 | $264.56 |
| RotaTeq | Merck | $87.35 | $101.99 |
| M-M-R II | Merck | $26.93 | $95.74 |
WHO 2024 Dose Volume vs Value
BARDA and SNS: Freeze-Dried Jynneos
BARDA awards Bavarian Nordic a 10-year freeze-dried Jynneos contract
Stockpile, not a retail schedule. Freeze-dried formulation is for long-term SNS storage. Contract HHSO100201700019C.
US draws down liquid-frozen Jynneos for the mpox outbreak
Outbreak demand consumes bulk that was meant for freeze-dried replenishment. That bulk has to be rebuilt.
BARDA orders $156.8M of Jynneos bulk replenishment
$139.7M bulk invoiced in 2024 plus storage services into 2027.
Additional BARDA order $63M for bulk and freeze-dried doses
Supports 1 million freeze-dried doses for 2026 delivery and more bulk for the freeze-dried conversion.
FDA approves freeze-dried Jynneos
Longer shelf life and easier storage than liquid-frozen. The SNS product, not the 2022 outbreak SKU.
BARDA exercises $143.6M of options for 2026 delivery
Public-preparedness revenue is option exercises, not ACIP retail.
BARDA exercises $97M more; remaining 11.5M-dose freeze-dried order for 2027
Company raised 2026 public-preparedness guidance to DKK 2.3B-2.5B after this option. Bulk invoiced in 2026; finished doses in 2027.
US Vaccine Policy Timeline, 2025 to 2026
HHS removes sitting ACIP members and reconstitutes the committee
The committee that writes US coverage rules is itself a policy risk. Subsequent votes and the new charter have been litigated.
CDC narrows childhood schedule (17 routinely recommended diseases to 11)
Issued outside the usual ACIP process. Sanofi and peers flagged US pediatric softness. Count is diseases, not shots.
Sanofi: 2026 vaccine sales 'slightly negative' on US weakness
Issuer primary. Management tied the dip to US coverage and public debate, with Beyfortus called out as not hit by the childhood-schedule edit.
Issuers report weaker US meningitis, COVID, pneumococcal, and flu
Policy risk showed up in the P&L, not only in headlines. Ex-US mix (Shingrix, Beyfortus rest of world) is the hedge.
Massachusetts district court stays the 2026 childhood-schedule rewrite and post-June 2025 ACIP votes
Preliminary stay, not a final judgment. Government appealed 29 Apr 2026. Do not treat the 11-disease schedule as current CDC law.
China Gardasil Destock
Prefer Sterling in Google
Add sterlingcharts.com as a preferred source so our charts can appear with a preferred badge in Google Top Stories, AI Mode, and AI Overviews.