The updated COVID-19 vaccine has arrived at large pharmacies in Chicago and is available to those who meet the federal Food and Drug Administration’s new, restrictive guidelines.
Everyone else — including some young children — is likely to get access to the shot in the city but might have to wait a few more weeks.
Doctors and medical experts say Illinois will likely issue more expansive recommendations that will support vaccinations for more people than the FDA’s limited recommendations. That could mean authorizing pharmacists to administer vaccines off-label, as they do in other states. Doctors already are authorized to give vaccines off-label.
It’s unclear, though, whether insurers will cover the costs over the long run for people who fall outside the FDA’s guidelines. For now, one of the largest private insurance companies, Blue Cross and Blue Shield of Illinois, hasn’t changed its coverage policy.
The FDA approved the latest version of the vaccine but only for those 65 or older or people with a high-risk medical condition. The FDA did not specify which medical conditions were eligible, but pharmacies offering the vaccine are relying on the past CDC’s definition of high-risk groups, which includes those who have asthma, who smoke or who are physically inactive.
The Illinois Department of Public Health plans to issue its own guidance by the end of the month after reviewing recommendations from medical societies, experts and its own immunization advisory committee as well as guidance from the U.S. Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices, according to Dr. Sameer Vohra, the agency’s director.
The FDA normally gives approval for a drug or a vaccine only if the agency has deemed it safe. It is usually the advisory panel’s responsibility to recommend who should get a vaccine and to set immunization schedules.
The CDC committee is scheduled to meet Sept. 18 and 19 to give formal recommendations for the COVID-19 vaccine, which medical experts say will determine accessibility and whether insurers will cover it.
“So now everyone is waiting for ACIP,” said Dr. Emily Landon, the executive medical director of infection prevention and control for the University of Chicago.
The uncertainties surrounding access to the vaccine comes amid a tumultuous period for the CDC, the federal agency many Americans had turned to for health guidance. Last month, several senior officials resigned after the head of the agency was abruptly fired. During a recent Senate hearing, Democrats called for Robert F. Kennedy Jr. to resign as secretary of the Department of Health and Human Services.
Where can I get the vaccine now?
The updated COVID vaccines are available at Walgreens and CVS throughout Illinois.
At Walgreens, the vaccine is offered without a prescription to anyone who meets the FDA guidelines. The pharmacy chain asks people to attest to their eligibility. People do need to present documentation of a high-risk underlying condition that would make them eligible.
A CVS spokesperson said the pharmacy chain can administer the vaccine to people in Illinois who meet the FDA guidelines and don’t have a prescription. CVS said “patients are asked to attest to their eligibility.”
Blue Cross Blue Shield of Illinois hasn’t changed its policy on covering vaccines, though the medical insurer says it’s reviewing the COVID guidance from the federal government.
If private insurers stop covering the vaccine for certain people, it’s estimated that the vaccine could cost $100 to $200 out of pocket, said Dr. Rebecca Maddrell, a Chicago family physician who is a fellow of the American Academy of Family Physicians. If those changes were to occur, insurers would likely not adjust until January.
The Chicago Department of Public Health plans to offer the updated COVID vaccine to anyone 6 months or older regardless of insurance or income, a spokesperson said. The department expects to receive the vaccine by late September or early October. The shots will be administered at its immunization clinics and during community vaccination events.
The number of COVID cases in Chicago has crept up slightly, according to city data. Test positivity is currently 5.2%, the highest since February.
Overall acute respiratory illness, including flu and RSV, remains minimal, the department reported.
Pediatricians await shipments
The FDA approved Moderna’s vaccine for children as young as 6 months, which is different from previous years. Children 5 years old and older can receive the Pfizer or Moderna vaccine.
But those vaccines are largely unavailable so far as providers wait for guidance on how many doses to order or await shipment, said Dr. Anita Chandra-Puri, a Chicago pediatrician and spokesperson for the American Academy of Pediatrics. The academy recommends the vaccine for children 6 months to just under 2 years and for all other children in a high-risk group.
The FDA did not recommend the vaccine for healthy children but says minors can get it after consulting a doctor. This is the only second time that the CDC and pediatrics academy’s vaccine recommendations have diverged in any significant way.
Children younger than 3 years old generally can get vaccinated only at their pediatrician’s office, Chandra-Puri said. She tells parents to get their children vaccinated before Halloween and said about 50% of her patients already have asked about when the vaccine will be available.
Lurie Children’s Hospital is also awaiting the updated COVID-19 vaccine, which is expected to arrive by late September, according Dr. Larry Kociolek, the Chicago hospital’s vice president of system preparedness, prevention and response.
Lurie is awaiting recommendations from the state and the advisory panel. Kociolek recommended parents review the CDC’s guidelines for which conditions are considered high risk.
“There’s several things besides the obvious, high-risk conditions that can put you at risk for complications from COVID and make you eligible for COVID-19 vaccine,” he said.
Vaccine science remains unchanged, doctors say
Maddrell said she is stressing to her patients that not much has changed about the vaccines despite confusion surrounding this year’s vaccine.
“The science is the same,” Maddrell said. “We know that these vaccines are effective at preventing against kind of severe illness, against hospitalizations, against death, against long covid — that is not changing.”
If the advisory panel’s recommendations mirror the FDA recommendations, there are still options for adults outside those criteria. Doctors can prescribe the vaccine off-label.
“As a physician, we have every right to be able to do that,” she said. “But, again, it’s just where do you get that vaccine?”
Insurance companies will be motivated to make sure customers can get vaccinated, Landon says, because vaccines are proven to keep down health care expenses and reduce missed days from work and school because of illness.
“Insurance wants to help their bottom line, and the bottom line is in favor of the vaccine,” Landon said.
For those insured through programs like Medicaid, the federal and state health insurance for low-income adults, coverage could come down to recommendations issued by each state, Maddrell said.
“It’s best to time your vaccines closer to the winter,” Landon said. “The shots work their best in the eight to 12 weeks after getting it — it’s the best at keeping you from getting sick during that window. And we are far off from a winter surge.”
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