The American College of Cardiology recommended Tuesday that all people with heart disease should get annual COVID-19 and flu vaccine doses, breaking with guidance from the Centers for Disease Control and Prevention under Health and Human Services Secretary Robert F. Kennedy Jr. 

The ACC’s 14-page Concise Clinical Guidance blends independent recommendations from the American Heart Association with last year’s recommendations from the CDC, but it marks the latest move from a nongovernment physicians association to issue its own guidelines in the midst of an uncertain future for vaccines under Kennedy’s leadership.

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The cardiology association argues that people with cardiovascular disease are at a higher risk of severe disease from COVID-19 and the flu, as well as other respiratory infections, such as respiratory syncytial virus, or RSV, and pneumococcal infections. 

Heart disease is the leading cause of death for men and women in the United States, with roughly 1 in 3 deaths in 2023 caused by cardiovascular disease. The healthcare system spends roughly $418 billion on heart disease annually, according to the CDC.

The organization recommends that people with cardiovascular disease receive annual COVID-19 and flu shots, as well as the one-time vaccine doses for RSV, pneumococcal, and shingles.

Dr. Paul Heidenreich, head of the writing committee for the guidelines, said in a press statement that the new guidelines’ goal was “to encourage clinicians to have these conversations and help their patients manage vaccination as part of a standard prevention and treatment plan.”

“Vaccination against communicable respiratory diseases and other serious diseases is critical for people with heart disease, but barriers exist to ensuring people are educated on which vaccines to get, how often to get them, and why they are important,” Heidenreich said. 

Public health advocates and medical associations have increasingly expressed concern that Kennedy’s Health and Human Services Department has been taking steps to limit vaccines for those who want them, particularly the mRNA COVID-19 vaccines.

In May, senior Food and Drug Administration officials unveiled plans to narrow approvals for COVID-19 vaccinations to adults over age 65 and for people at high risk of severe disease because of one or more underlying health conditions. The updated FDA recommendations list “heart conditions” as a possible risk factor that would warrant COVID-19 vaccination, but it does not specifically address cardiovascular disease. 

In June, Kennedy fired all 17 members of the CDC’s Advisory Committee on Immunization Practices, or ACIP, and replaced them with seven new members who are more skeptical of traditional vaccines and their approval procedures. 

Another point of concern for pro-vaccine advocates is the news that one of ACIP’s new members, Retsef Levi, is currently leading the COVID-19 immunization task force at HHS. Levi has previously called into question mRNA COVID-19 shots and called for them to be removed from the market. 

The ACC’s clinical guidance packet briefly notes the importance of ACIP’s recommendations because the products that the committee recommends are required to be covered by insurance companies. But the ACC also notes the importance of what it calls “functional access” to vaccines, particularly through doctors’ offices and, in this case, cardiology clinics.

According to the ACC, only 30% of physicians assess their patients’ vaccination history at clinical visits. 

“Cardiology clinics are an important opportunity for patients to receive vaccination as patients may feel more comfortable discussing how vaccination fits into their treatment plan with their cardiologist rather than with a primary care physician,” the document reads. 

The ACC isn’t alone in issuing its own recommendations for a specific type of patient.

Last week, the American Academy of Pediatrics made a similar move, recommending that children between the ages of 6 months and 23 months receive the COVID-19 vaccine, citing their high risk of severe disease. 

Following the AAP’s independent guidance, Kennedy posted on X that the medical organization was “angry” that the CDC changed its vaccine recommendations due to corporate influence in AAP decision-making.

Pfizer and Moderna, makers of the COVID-19 vaccine, and other vaccine manufacturers are top donors to the AAP.

Kennedy said the divergence of the AAP from CDC recommendations should make people question whether the AAP’s guidance is “just a pay-to-play scheme to promote commercial ambitions of AAP’s Big Pharma benefactors.”

In the context of the ACC, Bristol Myers Squibb and Janssen, both of which make blood-thinning medication to prevent strokes and heart attacks, are listed on the medical organization’s website as having contributed more than $1 million to an ACC 2021 financing campaign. AstraZeneca and Merck & Co. donated less than a million but more than $100,000.

It’s not clear how the updated guidance from either the ACC or the AAP will affect COVID-19 vaccine uptake. 

According to a survey conducted by the nonpartisan health policy group KFF earlier this month, nearly 6 in 10 Americans said they were not planning on getting an updated COVID-19 shot for the 2025-2026 cold and flu season. That included 37% saying they were “definitely not” getting the jab. 

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About a third of respondents in that survey said they were concerned that policy changes for the COVID-19 vaccine from Kennedy’s HHS would decrease the availability of COVID-19 vaccine doses or would make it such that they would no longer be covered by insurance. 

About 40% of those over age 50 were most concerned about access and insurance coverage, according to the KFF survey.