Virginia is moving to ensure residents have quick access to the latest COVID-19 vaccines ahead of the fall respiratory illness season, with State Health Commissioner Dr. Karen Shelton signing a statewide standing order this week that expands pharmacy vaccination authority.
The order, signed Tuesday and announced Thursday, allows pharmacists across Virginia to administer the 2025-26 COVID-19 vaccine formulation to residents 65 and older, as well as adults aged 18-64 with underlying medical conditions, without requiring individual prescriptions.
“We realize this has been top of mind for many Virginians in the past several days,” Shelton said in a press release, “and we are resolved to increase access to the updated formulation of the COVID-19 vaccine to all eligible Virginians.”
The timing reflects a gap in the typical vaccine rollout process. While the Centers for Disease Control and Prevention’s current immunization schedule still references the 2024-25 COVID vaccine formulation, the newer 2025-26 version is expected to provide better protection against strains anticipated to circulate this season.
The CDC’s Advisory Committee on Immunization Practices is scheduled to meet Sept. 18-19, with Virginia health officials expecting the panel to vote on recommendations for the updated vaccines. Following that meeting, the CDC director or the Health and Human Services secretary would formally endorse the recommendations.
Rather than wait for that federal process to conclude, Virginia is positioning pharmacists to begin administering the updated shots as soon as they become available.
Four vaccines authorized
The standing order covers four different 2025-26 COVID vaccines: MNEXSPIKE, SPIKEVAX and COMIRNATY — all mRNA vaccines — plus NUVAXOVID, a protein-based vaccine. Each has specific dosing protocols depending on the recipient’s age and vaccination history.
For adults 65 and older, all four vaccines are available under the standing order. Adults 18-64 with underlying medical conditions can also receive any of the four formulations without a prescription.
Adults between 18 and 64 without underlying health conditions, as well as anyone under 18, are encouraged to consult their health care providers about COVID vaccination rather than relying on the pharmacy standing order.
The order provides detailed guidance on timing between doses, with most vaccines requiring at least two to three months between shots for previously vaccinated individuals.
Safety protocols required
The four-page standing order includes extensive safety measures, requiring pharmacists to screen for contraindications and maintain emergency protocols for allergic reactions. All vaccine recipients must be observed for at least 15 minutes after vaccination, with those who have a history of severe allergic reactions observed for 30 minutes.
Specific contraindications include previous severe allergic reactions to vaccine components, with additional precautions noted for individuals with histories of heart inflammation or severe acute illness.
Pharmacists must maintain detailed records, report vaccinations to the Virginia Immunization Information System within seven days and provide recipients with vaccination cards noting when they need to return for second doses if applicable.
Under Virginia law, pharmacists can administer vaccines either through direct authorization from medical providers or by following statewide pharmacy protocols that align with CDC guidelines. The new standing order provides direct authorization for the specific populations covered.
The move comes as respiratory illness seasons typically begin ramping up in the fall and winter months, with health officials encouraging vaccination before increased transmission periods.
