To the editor: Dr. James W. Lederer's Aug. 8 column "Deciding on vaccines is between you and your doctor or your child's pediatrician" included his wise advice to seek guidance from our physicians as to which vaccines are appropriate.

Many are now confused about this because the carefully designed system for the annual respiratory vaccine rollout has been disrupted by Health and Human Services Secretary Robert F. Kennedy Jr., a vaccine critic who is now in charge of this system.

Until now, the rollout followed a specific order: In February, Food and Drug Administration advisers select vaccine formulas; in spring, expert advisory groups recommend which versions to use based on strain; in summer, manufacturers scale up production and the Centers for Disease Control and Prevention defines eligibility; in August, the FDA finalizes labeling and insurers confirm coverage; in fall, providers stock shelves, patients show up and are vaccinated.

This orderly cascade has been disrupted, causing confusion and potentially affecting access. Expert advisers such as the American Academy of Pediatrics have been removed, and the members of the Advisory Committee on Immunization Practices (ACIP) were replaced by vaccine skeptics. As a result, CDC, FDA, and HHS are issuing conflicting advise on, for example, who should receive the COVID-19 vaccines. This inhibits planning, erodes confidence and causes uncertainty among physicians as to what advice to dispense.

The COVID-19 vaccine rollout has been most severely affected. Amazingly, there is no national recommendation on who should get the updated vaccine. This occurs in June when the ACIP votes on it, but the new ACIP may not do so until later this month. This delay will affect insurance coverage, and the number of doses pharmacists should order. The FDA is expected to restrict eligibility only to "high-risk" people: those who are over 65 or who have certain, unspecified underlying conditions. This could reduce vaccine uptake and increase COVID spread in the community.

Those not at high risk but who were advised by their physician to be vaccinated would need to get the vaccine "off-label." This might be difficult in the case of vaccines because pharmacies might not be permitted by their corporate owners to honor off-label prescriptions, insurers might not cover the cost and physicians might not be willing to prescribe vaccines off-label.

We might follow the appropriate recommendation by Dr. Lederer to seek advice from our doctors, but we might not be able to act upon that advice.

Dr. Charles I. Wohl, Lenox