As the muggy malaise of summer winds down, you might find yourself interested in taking advantage of one of several safe and proven vaccines to help protect you from the inevitable brumal surge of respiratory illnesses. You might be interested in conveniently booking an appointment at your local pharmacy, showing up on time, and walking away with a cutesy band-aid and the knowledge that you are lucky to partake so easily in the storied, life-saving tradition of immunization. But this is not how things work now, here, in Robert F. Kennedy Jr.’s America.
On Aug. 27, the Food and Drug Administration approved this year’s COVID-19 vaccines, which were previously recommended for most adults to protect from severe illness, hospitalization, and death. But the new vaccine comes with new, prohibitive guidelines designed to make it difficult for most people to get it. In a post on Twitter, Kennedy said the guidelines fulfilled his promises to “end covid vaccine mandates” and “keep vaccines available to people who want them, especially the vulnerable.”
This is a lie. The new guidelines erect enormous barriers for people who want the vaccine, including the vulnerable. The guidelines will result in fewer people getting the vaccine, which will result in more people dying. As someone who is under 65 years old and wants a COVID-19 vaccine, I set out to understand how available they really are. You will never guess what I found!
Who can get a COVID vaccine, according to the government?
In past years, the FDA approved and recommended the COVID vaccine for all people six months and older. Now, the FDA has limited this approval to people older than 65, and people who are older than 6 months who have a condition that puts them at high risk. As Katelyn Jetelina explains in her newsletter, Your Local Epidemiologist, “It is highly unusual for the FDA to restrict its approval for a drug in this way.”
They also contradict the recommendations of major medical associations such as the American College of Obstetricians and Gynecologists, which recommends all pregnant individuals get the vaccine. Getting a vaccine during pregnancy confers passive immunity to the infant, offering babies extra protection when they are too young to receive the vaccine. But who gives a shit about medical experts these days? Not the federal government.
How do I know if I’m high risk?
The Centers for Disease Control and Prevention has a list of high-risk underlying conditions for COVID that was last updated in February. The list includes asthma, cancer, diabetes, disabilities, heart conditions, HIV, mental health conditions such as depression, pregnancy, smoking, and using immunosuppressive medications, among other conditions. Fortunately for vaccine-wanters, it’s a pretty expansive list. Perhaps unfortunately for vaccine-wanters, that list could change within weeks. The Advisory Committee on Immunization Practices, or ACIP, which historically instructs the CDC on vaccine policy and will meet mid-September. Also, it’s unclear what on Earth is happening at the CDC right now.
Wait, what’s ACIP?
The Advisory Committee on Immunization Practices advises the CDC on guidelines for vaccine policy—who gets them and at what doses and intervals. Insurance companies rely on these recommendations to decide who should be covered and how. Normally this meeting happens in June, far ahead of flu season. But RFK Jr. ousted all 17 members of ACIP in June and replaced them with eight people he hand-picked for valuable expertise such as failing to disclose conflicts of interest and claiming that the COVID vaccine kills children. This new ACIP committee will meet for two days starting on Sept. 18 to issue a formal recommendation on this year’s vaccine. I am sure that meeting will be very normal and based on real facts.
I’m high-risk and I want the vaccine. Can I walk into a pharmacy and get it?
No, because that would be easy, and anti-vaccine activists do not want vaccines to be easy to get. Currently, vaccine access varies by state, because some states have guidelines that require approval from CDC and some set their own. This list might change at any time, but this is the current lay of the land, according to CBS News.
CVS is offering COVID vaccines in Alaska, Alabama, Arkansas, California, Connecticut, Delaware, Hawaii, Iowa, Idaho, Illinois, Indiana, Kansas, Maryland, Michigan, Minnesota, Missouri, Mississippi, Montana, Nebraska, North Dakota, New Hampshire, New Jersey, Ohio, Oklahoma, Oregon, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Vermont, Washington, Wisconsin and Wyoming.
In the other 16 states, and the District of Columbia, CVS will only vaccinate someone for COVID-19 if they get a prescription.
The same should be true for Walgreens, right? How dare you assume there would be any semblance of logic here. According to the New York Times, Walgreens requires a prescription for a vaccine appointment in 16 states, which is not the same set of 16 states than those in which CVS requires a prescription.
Navigating this will be extremely annoying. So annoying, in fact, that many busy people will probably decide they have better things to do with their time, and not get a vaccine at all. And many people don’t have access to a doctor at all; they too will not get vaccinated.
At the end of the day, just remember that these rules could all change at any time.
What if I am not considered high-risk, but I still want a COVID-19 vaccine?
Congratulations on your good health! Unfortunately you are in a bit of a pickle. Because you’re not covered by the FDA requirements, you would need to get the vaccine off-label, which means receiving the vaccine outside of the terms for which the FDA approved it. Pharmacists cannot give vaccines off-label, so you will be turned away from CVS or Walgreens. You can technically get an off-label vaccine from your doctor, but some physicians may be uncomfortable administering off-label vaccines because of liability concerns. If you do manage to snag a vaccine, you might have to pay for it. An out-of-pocket COVID shot will run you upwards of $150.
Can I just lie and say I’m high-risk?
Typically, people are able to self-attest to a condition and receive a vaccine without showing proof. If you are not in one of the 16-ish states requiring a prescription for a COVID vaccine, you should be able to self-report a condition and receive your vaccine.
You could also theoretically ask your doctor for a prescription, even if you don’t have a qualifying high-risk condition. What they do with this information is between the two of you, God, and HIPAA.
How can I get my kid a COVID vaccine?
Even though RFK Jr. said COVID vaccines are no longer recommended for healthy children, the American Academy of Pediatrics still recommends all kids between 6 months and 2 years get the vaccine. There is only one vaccine for children under 5 this year, the one from Moderna SPIKEVAX. Pfizer’s COMIRNATY vaccine is available for kids 5 and up, as well as Novavax’s NUVAXOVID for teens 12 and up. Again, this all depends on whether your child has a high-risk condition, or whether their pediatrician is willing to administer an off-label vaccine.
This is stressful and confusing. Should I even get a COVID vaccine?
It is stressful, confusing, and deeply unfair. But the COVID-19 vaccine remains safe and effective. It’s true that more people have some level of immunity now, which has mellowed the virus’s threat since the early days of the pandemic. But, as Jetelina explains, immunity works on two levels: short-term antibodies and long-term T cells. Although T cells can linger in your bodies for years, antibodies fade within four months. And high-risk populations can have weakened immune systems. So if you haven’t been infected or vaccinated recently, you’re at a higher risk of getting COVID and spreading it. To take care of yourself and others, you should do the opposite of what RFK Jr. is suggesting and get a COVID vaccine if you can. This advice is might be a good rule of thumb for your broader personal health: if RFK Jr. thinks something is bad for you, it’s probably good, and vice versa.
Will there even be COVID vaccines in the future? Or vaccines more generally?
Truly who knows? In August, RFK Jr. cut $500 million in funding for mRNA vaccines, the technology behind COVID vaccines. This is an extraordinarily dangerous decision considering the rising specter of a bird flu pandemic. “To replace the troubled mRNA programs, we’re prioritizing the development of safer, broader vaccine strategies, like whole-virus vaccines and novel platforms that don’t collapse when viruses mutate,” RFK Jr. said in a video posted to social media. As opposed to mRNA vaccines, which deliver instructions to create a harmless piece of a protein to trigger an immune response, whole-virus vaccines contain the entire virus. Whole-virus vaccines take much longer to develop and are far less effective than mRNA vaccines. This technology is, unsurprisingly, not a recent feat of technology but “actually ancient, sort of, by vaccine standards,” Angela Rasmussen, a virologist at the University of Saskatchewan, told NBC News. This is a logical endpoint of RFK Jr.s agenda. Why be healthy when we could be sick? Why live when we could just die?
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