The fall COVID vaccines received FDA approval recently, but had significant changes to who can get them. These changes mean that the COVID-19 vaccines may be harder to access this year than in the past. But their importance has not changed, nor has the science that supports their effectiveness. If you have the ability, you should discuss access with your clinician, and remember that tools like masking and ventilation can also help reduce your risk of infection.
What did the FDA decide?
In August, the FDA rescinded the emergency use authorization that allowed people to get the COVID vaccine. The FDA then did fully approve updated shots, but they changed the official recommendations for who could get one. There are currently three COVID vaccines that are approved. However, they were approved for older ages and those at high risk, whereas before they were recommended for everyone over six months of age.
- Moderna has an mRNA vaccine that is approved for use in anyone over six months old with at least one underlying condition, and for everyone over 65.
- Pfizer has an mRNA vaccine that is approved for use in anyone over five years old with at least one underlying condition, and for everyone over 65.
- Novavax has a protein vaccine that is approved for use in anyone over 12 years old with at least one underlying condition, and for everyone over 65.
What did the Advisory Committee on Immunization Practice (ACIP) decide?
Once the FDA approves a vaccine, the ACIP committee makes recommendations on how the vaccine should be used. This committee met on Sept 19th, and they voted that anyone 6 months or older could access COVID-19 vaccines after a process known as shared clinical decision making [archived link]. Shared clinical decision making means that you and your healthcare provider make a choice together. Instead of the clinician just telling you what you can or cannot do, they should tell you the options, explain the benefits and risks of each option, and listen to your values and preferences. Then, you decide on a plan of care together. According to the CDC this can be done with anyone who can administer the vaccine. This means it could be with a clinician or with a pharmacist.
Overall, this is good news, but the acting CDC director still needs to approve these decisions. If he does, it means it may be easier than originally thought for people who want a COVID-19 vaccine to access one. However, states may vary in whether or not they still require a prescription due to the FDA label change mentioned above.
What are the underlying conditions that make someone higher risk?
Currently, there is a long list of conditions on the CDC website (see below). It is unclear if these will change. Unfortunately, although pregnancy was on the list, the new recommendations specifically exclude pregnancy. American College of Obstetricians and Gynecologists (ACOG) has expressed extreme disappointment in this exclusion and is strongly advocating for continuing to recommend COVID vaccine during pregnancy.
What do other organizations think about this change?
📃 Many organizations, such as the American Association of Pediatrics (AAP), American College of Obstetrics and Gynecology (ACOG), Pediatric Infectious Disease Society (PID Society) and Infectious Disease Society of America (IDSA) have come out with statements about these changes and have expressed concern about limiting access to COVID-19 vaccines. All have stated clearly that it is critical that access remains open to all who want them. Additionally, for the first time ever, the AAP has developed their own guidelines for the childhood vaccine schedule (https://publications.aap.org/aapnews/news/32835) that are based on scientific evidence.
Why does this matter?
😷 With a contagious respiratory virus, the fewer people who get a vaccine, the more it will spread.
We know protection from the COVID vaccine decreases over time. Thus, more people will get sick.
🚨 Nerd alert: When more people get sick, the virus has more chances to make copies of itself and change, or mutate. When a virus changes, the effects can vary. Sometimes nothing happens. Other times, the change makes the virus weaker and it can’t survive. But sometimes the change gives the virus an advantage—like making people sicker, spreading more easily, or slipping past the immune protection our bodies built up from past infections or vaccines.
🧑🏽🍼 If young children can’t get their first COVID vaccines, then they are left at greater risk of getting severely ill when they eventually get infected. Removing their ability to get a COVID-19 vaccine puts them at risk for unnecessary harm.
Children can also get long COVID or Multisystem Inflammatory Syndrome in Children (MIS-C, a rare but serious condition after infection).
💉 Many people may know they have a health condition that puts them at higher risk, but in some states they will still need a doctor’s approval before they can get the COVID vaccine.
Last year, more than 90% of vaccines were given at pharmacies, yet pharmacies can only give the shot to people on the official eligibility list.
Some pharmacies may allow self-attestation – where you just confirm you have a condition that makes you eligible. Other pharmacies will require a doctor’s prescription. This creates new barriers for people, especially for those without a primary care provider or children who may not yet have a diagnosis but are still at risk of severe illness.
🚫 Representatives from the administration say they are not restricting access and that anyone who wants a vaccine can get one, but the reality is that CDC recommendations are what insurance companies use to determine their coverage.
Despite pressure from the AAP and other medical organizations, it is possible that at least some insurance companies will refuse to pay for the COVID vaccine for people who are not in the groups recommended to get it. This means they will have to pay out of pocket, which many people can’t afford to do. It could cost more than $200 per person for the vaccine. If it needs to be given at a doctor, then you need to add on co-pays and the lost work time to take everyone to the doctor.
🙅 Several states and groups of doctors have pushed back against the restrictions as well. For example, Oregon, Washington, and California have formed a Western Health Alliance that will create its own recommendations for vaccines. The governor of New York declared a statewide disaster emergency [archived link] to preserve access to the vaccine. Massachusetts is also [archived link] putting in place measures to ensure access to vaccines, require insurance companies to cover their costs, and join with other states to provide vaccine recommendations, disease surveillance, and emergency preparedness. These state actions are changing quickly, so make sure to check with your state to see if they’re starting similar policies.
Stay well,
Those Nerdy Girls
Further reading:
Estimates of lives saved each year with vaccines
CDC – Fast Facts on Global Immunizations [archived link]
WHO – Vaccines and Immunizations
Estimates of lives saved with COVID vaccines
PubMed – Global Estimates of Lives and Life-Years Saved by COVID-19 Vaccination During 2020-2024
Those Nerdy Girls Posts on Vaccines
Recent post on COVID vaccine updates
What are the current COVID vaccine recommendations and how have they changed?
What COVID vaccines will be available this fall to protect you and your family?
