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 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
