By Lisa Jarvis / Bloomberg Opinion
As vaccine season approaches and covid cases tick up in some parts of the country, friends and colleagues keep pinging me with the same question: “Can I still get a covid booster?”
Unfortunately, there’s no simple answer. My short version goes something like this: Probably; but it might be harder to find, and you may have to pay for it out of pocket.
The longer version? It’s complicated. Health and Human Services Secretary Robert F. Kennedy Jr. and leaders at the Food and Drug Administration and the National Institutes of Health have created widespread confusion around the shots; not only about who’s eligible, but also by casting doubt on whether the vaccines are safe or even necessary. That uncertainty has already prompted at least one major medical group to offer its own, evidence-based recommendations.
But the disconnect between the official HHS messaging and expert medical guidance has left patients in a gray area. There’s a lot of room for interpretation — and inconsistency — in how the shots will be offered, recommended or covered by insurance.
The result? Some people who want to be vaccinated may walk into their doctor’s office or local pharmacy unsure about whether they qualify, or how much it might cost. Access could be especially uncertain for young children and pregnant women, who also are among the most vulnerable to the disease.
“The secretary has thrown so much confusion into the environment that anybody who wants to get vaccinated could encounter challenges,” says Richard Hughes IV, a partner at Epstein Becker & Green PC, and lead counsel in a lawsuit against Kennedy and others at HHS by medical groups over the covid recommendations. “Even experts have had a difficult time grappling with the chaos and confusion.”
That escalated in May, when Kennedy and FDA Commissioner Marty Makary introduced new guidelines for who should receive covid vaccines. Their policy restricted the shots to high-risk groups: older Americans and individuals with underlying health conditions that make them especially vulnerable.
They also recommended removing the shots from the list of routine immunizations for healthy children, a position the Centers for Disease Control and Prevention later softened. Rather than endorsing annual boosters, which many pediatricians agree might not be necessary for everyone, the CDC said that the decision should be made through shared-decision making; meaning parents and doctors should discuss whether to vaccinate.
However, these policies notably exclude a clear recommendation — typically required for insurance coverage — for two vulnerable groups: healthy pregnant women and children under the age of 2.
In response to growing concern over this messaging, public health groups are stepping forward to offer their own guidance. On Tuesday, the American Academy of Pediatrics released guidelines emphasizing the importance of initiating covid vaccination in infants aged 6 to 23 months, who face a similar risk of serious infection as adults in their 50s, according to Jesse Hackell, a retired pediatrician and chair of the group’s pediatric workforce committee. The AAP also advised that children who are at high risk for severe disease should get a booster, as should any healthy kids whose parents desire one.
What do these conflicting stances mean for parents who want their child to be vaccinated? The AAP says that conversations with private insurers suggest they will continue to cover kids’ shots, which would ease access for the roughly half of American children covered by private insurance. “I can’t speak for all carriers, but we’ve gotten pretty positive feedback,” Hackell says.
The situation is less clear for children with public insurance. Their shots are covered through the federally funded Vaccines For Children (VFC) program, which is required to provide — at no cost — any shots recommended by the CDC’s Advisory Committee on Immunization Practices (ACIP). But Hackell says there’s uncertainty about whether the program would pay for vaccines for healthy children under a shared decision-making model.
Even kids with private insurance could be out of luck if pediatricians choose not to stock the vaccine. During the early years of the pandemic, the government distributed vaccines for free. But once distribution shifted to the commercial market, some pediatric practices bought only limited supplies; and last fall, as vaccination rates waned, many didn’t order any supplies at all. With public messaging around the vaccines so mixed this year, many doctors are even more hesitant to waste money on doses that might go unused.
Parents could turn to their local pharmacy, but that, too, presents challenges. States vary in their laws about the minimum age at which pharmacists or technicians can administer the shots to children, with some having no restrictions, and others setting minimum ages ranging from 4 to 14.
Taken together — shifting guidelines, uncertain insurance coverage and inconsistent availability — these factors could leave parents of infants struggling to secure their child’s first round of shots, and frustrate those who want their older children to receive an added layer of protection.
Even with the decline in vaccination rates, millions of Americans still want to reduce their own risk of infection, protect vulnerable family members and ensure their children are protected. They should have access to that option; and it shouldn’t be mired in confusion or bureaucratic hurdles, especially those created by US health agencies.
Lisa Jarvis is a Bloomberg Opinion columnist covering biotech, health care and the pharmaceutical industry. Previously, she was executive editor of Chemical & Engineering News.
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