ATLANTA (AP) — Health Secretary Robert F. Kennedy Jr.’s new team of vaccine advisors injected uncertainty into this fall’s COVID-19 vaccination plan by opting not to endorse the shots for everyone, leaving the decision to individuals who wish to receive it.

Previously, these vaccinations were routinely available to nearly every American interested. Recent changes by the Food and Drug Administration have imposed new limitations on the shots from Pfizer, Moderna, and Novavax, making them available mainly to those over 65 or younger individuals considered to be at higher risk from the virus.

The advisors to the Centers for Disease Control and Prevention did not give a firm recommendation for vaccination in their series of votes, instead allowing individuals to make personal choices.

The panel also recommended that the CDC adopt stronger language regarding the potential risks of vaccination, a suggestion met with opposition from external medical organizations that pointed to the vaccines’ established safety record.

And the divided panel narrowly avoided urging states to require a prescription for the shot.

Dr. Sean O’Leary from the American Academy of Pediatrics criticized the lack of a strong recommendation for vaccination as “extraordinarily vague,” warning it could have “immediate effects on American children.”

He said the discussion involved clear efforts to “sow distrust” about vaccines.

“It was a very, very strange meeting,” O’Leary said.

While the COVID-19 vaccines are not flawless, CDC data indicates they offer the best defense against severe illness and death, even if vaccinated individuals may still contract the virus. As the virus continues to change, people may face repeated infections.

Like flu vaccines, COVID-19 shots now are being updated yearly, but only about 44% of seniors and 13% of children were up-to-date on the coronavirus vaccinations last year, the CDC said.

“If you make a recommendation that people are simply not going to follow, I don’t think that’s wise,” said panelist Dr. Cody Meissner of Dartmouth College.

Another question concerns a very rare side effect mostly in young men — a kind of heart inflammation called myocarditis — that was discovered in the early days of vaccination in 2021. A scientist studying whether people with certain genes are uniquely susceptible to that risk told the panel the Trump administration had canceled his grant before the research could be finished.

The panel took up COVID-19 vaccinations as the virus remains a public health threat. CDC data released in June shows the virus resulted in 32,000 to 51,000 U.S. deaths and more than 250,000 hospitalizations last fall and winter. Most at risk for hospitalization are seniors and young children — especially those who were unvaccinated.

Worried about access, leading medical groups including the American Academy of Pediatrics already have issued recommendations that the vaccines be available to anyone age 6 months and older who wants one — including pregnant women — just like in prior years.

Several states have announced policies to try to assure that access regardless of Friday’s ACIP decision. And a group representing most health insurers, America’s Health Insurance Plans, said earlier this week that its members will continuing covering the shots through 2026.

The panel opened the second day of its meeting with continued confusion over a question it left hanging Thursday: whether to end a longstanding CDC recommendation that all newborns be vaccinated at birth against a liver virus, hepatitis B.

The panel had been considering whether to recommend delaying that initial vaccination — something doctors and parents already can choose to do. But amid criticism from independent pediatric and infectious disease specialists who say the vaccine is safe and has helped infant infections drop sharply, the advisers decided Friday to postpone that decision.

On Thursday, the panel recommended a new restriction on another childhood vaccine.

They recommended that for children under 4, their first dose of protection against MMR — measles, mumps and rubella — and chickenpox should be in separate shots, not a combination version known as MMRV. Since 2009, the CDC has said it prefers separate shots for initial doses of those vaccines and 85% of toddlers already do.

On Friday, the committee also recommended that the government’s Vaccines for Children program — which covers vaccine costs for about half of U.S. kids — align its guidance with that narrower MMRV usage.

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Neergaard reported from Washington. Associated Press writer Laura Ungar in Louisville, Kentucky, contributed to this report.

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The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Department of Science Education and the Robert Wood Johnson Foundation. The AP is solely responsible for all content.