For the first time since the COVID vaccines became available in pharmacies in 2021, the average person in the U.S. can’t count on getting a free annual shot against a disease that has been the main or a contributing cause of death for more than 1.2 million people around the country, including nearly 12,000 to date this year.
“COVID’s not done with us,” says Jennifer Nuzzo, an epidemiologist at Brown University. “We have to keep using the tools that we have. It’s not like we get to forget about COVID.”
In recent weeks, the Department of Health and Human Services, led by prominent antivaccine activist Robert F. Kennedy, Jr., has announced a barrage of measures that are likely to reduce COVID vaccine access, leading to a swirl of confusion about what will be available for the 2025–2026 season. HHS officials did not respond to a request for comment for this article.
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Government officials appear to be limiting COVID shots to people who are aged 65 and older and to those who have certain preexisting health conditions—groups that have long been known to face a higher risk of developing severe COVID. Pregnant people and some children, meanwhile, appear to be explicitly excluded from access, despite plentiful evidence that vaccines are very safe and effective for them and that COVID infections can cause them significant harm.
Scientific American spoke with clinicians and public health experts about the latest COVID vaccine recommendations, what access may look like this fall and how these policies might influence people’s vaccination choices and health.
What COVID vaccines will be manufactured this year?
Public health experts are monitoring a strain of the COVID-causing virus SARS-CoV-2 called NB.1.8.1, which was first detected early this year and last month became responsible for one in 10 COVID cases globally. So far, the new variant has mostly been reported in Asia and Europe. But it has also been picked up in airport surveillance in multiple U.S. states, says Peter Chin-Hong, an infectious disease physician and a professor of medicine at the University of California, San Francisco.
The emergence of a new variant isn’t surprising, particularly at this time of year, Chin-Hong says. “It’s kind of acting like clockwork—maybe this might be the variant of the summer,” he adds. Still, NB.1.8.1 has led to concerns about a potential surge in cases—although Chin-Hong and other scientists don’t have any evidence so far that it causes more serious disease than other currently circulating strains.
“All of these new variants, they might be more transmissible, they might be more immune evasive, but I’ve seen no data whatsoever that suggests that they’re more pathogenic,” says Angela Rasmussen, a virologist at the University of Saskatchewan.
Within the U.S., a strain called LP.8.1 has been the most common one detected since March. Both NB.1.8.1 and LP.8.1 are among the alphabet soup of strains that descended from a key ancestor lineage called Omicron JN.1, which dominated U.S. cases by early 2024.
Current vaccines target this category of strains. And in May a Food and Drug Administration panel determined that, this year, vaccine producers should again tailor their shots to a single strain within the JN.1 lineage—preferably LP.8.1.
What’s going on with COVID vaccine policy?
Strain selection aside, the recent messaging and decision-making on vaccine policy for COVID and beyond have been chaotic, with various governmental groups and officials announcing different access guidelines and restrictions.
“The situation we’re in right now is nuts,” says Nuzzo, referring to the fact that agency leaders have sidestepped the formal science committees that traditionally make vaccine-related decisions. “We don’t change vaccine policy on a willy-nilly basis. There’s an incredible amount of nuance, and all of the data need to be considered.”
But on June 9 Kennedy took a major step against this evidence-driven decision-making process by firing the entire CDC Advisory Committee on Immunization Practices (ACIP). Kennedy announced the committee rehaul in a Wall Street Journal op-ed, in which he alleged there were “persistent conflicts of interest” among committee members.
Drazen Zigic/Getty Images
According to a recent HHS statement, new committee members are under consideration, and the group will still meet as scheduled from June 25 to 27. ACIP has traditionally been particularly important because any vaccine it recommends must be fully paid for by health insurance companies—a condition that greatly determines real-world access. It’s unclear what the committee’s overhaul will mean for COVID vaccine access in particular.
Another concern is that Kennedy announced in late April that HHS would implement a policy requiring all “new” vaccines—including updated versions of existing ones, such as COVID shots—to be tested against a placebo.
The original COVID vaccines were tested in just this manner. But conducting similar tests when an effective and very safe vaccine already exists would be not only unethical for researchers but also expensive and time-consuming for manufacturers. It remains unclear when the new policy will take effect.
What does this mean for COVID vaccine access this fall?
If you are 65 years old or older, you should be able to get a COVID shot as you have in recent years.
If you have an underlying condition such as cancer, diabetes, or heart or lung problems, you may also be able to get a COVID shot as usual. These issues and several others are on the CDC’s list of conditions that leave people more vulnerable to severe disease, and this list is included in the description of the new regulatory framework. One 2021 study looked at many (but not all) of the conditions on the list and estimated that three in four U.S. adults has at least one. People are allowed to self-disclose a preexisting condition at pharmacies without a prescription or doctor’s note.
That list could also be expanded later if new research finds other risk factors that increase people’s risk of severe COVID, says Jacinda Abdul-Mutakabbir, a clinical pharmacist and an assistant professor at the University of California, San Diego.
But there’s also a chance that qualifying conditions may be reduced instead. For example, current or recent pregnancy is included in the CDC’s existing list, but HHS officials announced in late May that the COVID vaccine would no longer be recommended for pregnant people.
Data have shown that COVID may cause various complications during pregnancy—increasing the risk that the pregnant person may require emergency care, be put on a ventilator or die. The newborn child of an infected person is also more likely to be born preterm or to have low birth weight. And babies younger than six months old—who are ineligible for vaccination because of their immature immune system—have the highest rates COVID hospitalization after adults aged 75 and older. In contrast, evidence from people vaccinated during pregnancy show that newborns receive protective immunity through antibodies that cross the placenta and are found in breast milk, Chin-Hong explains.
Healthy children also face new restrictions to COVID vaccine access: The shot is now only recommended to them based on “shared clinical decision-making,” according to the vaccine schedules released by the CDC last month. This means parents must consult with a health practitioner about whether to vaccinate such children.
Experts worry about the consequences of restricting access for kids. Children under age 18 make up a smaller percentage of COVID hospitalizations and deaths. But that doesn’t mean zero risk, Chin-Hong says. “We know that COVID still kills kids,” he says. “No death of a child is a good death—and these are all preventable.”
“Because children and pregnant people are considered vulnerable populations, they were not included in the original studies that were done for the COVID vaccines,” Abdul-Mutakabbir says. But five years’ worth of real-world vaccine data from these groups show the health benefits. “We do see effectiveness and safety in these vaccines,” she says.
It’s still possible that the late June ACIP meeting will shift the landscape again. But if you want a COVID vaccine this fall and don’t meet current guidelines, you may still be able to request a shot. Your insurance may not pay for it, however, leaving you to risk a price tag of around $200.
“Insurance companies or providers are only required to pay for vaccines that are listed as recommended by the CDC,” Abdul-Mutakabbir says. Full, partial or no-cost coverage for nonrecommended vaccines is at the insurance provider’s discretion. Any changes to coverage—and the times at which those changes are announced—will vary among programs, including private and governmental ones, such as the federal-state program Medicaid and the federal program Medicare.
Until then, Chin-Hong and Abdul-Mutakabbir say, the COVID vaccines released in the fall of 2024 are still recommended and available to people who haven’t already had one. And as of April 26, only 23 percent of adults and 13 percent of children in the U.S. had received the shot. “If you are nervous about the surge or planning summer travel, I would recommend” getting the vaccine, Abdul-Mutakabbir says.
The larger fight over vaccines
For Rasmussen, the confusion over COVID shots signals the beginning of a longer tug-of-war—with Kennedy’s HHS on one end. “I think I know what their plan is, and it’s to reduce access to vaccines in general,” she says. “In my view, this is an incremental step in a larger attack on vaccination in general.”
She encourages people worried about vaccine restrictions—and about the role of science in making these decisions—to call their congressional legislators. “A lot of people speaking out is what is needed right now to make a big difference here,” she says.
Abdul-Mutakabbir also hopes people continue to seek vaccines for COVID and other diseases—especially while they are still easily available.
“It’s important that we consider the things that we can protect ourselves against,” Abdul-Mutakabbir says. “Should you have a barrier with getting a COVID vaccine, guess what? There’s no change to the flu vaccine; there’s no changes to the pneumococcal recommendations; there’s no change to measles, mumps, rubella vaccine. Get the vaccines that we can get.”
