What We Know and Don’t Know About COVID-19 Vaccine Eligibility

Want a COVID-19 vaccination this fall? For many Americans, it’s not clear how easy it will be to get one – or if they’ve lost the choice.

Health Secretary Robert F. Kennedy Jr., a former prominent figure in the anti-vaccine movement, announced this week that vaccinations are no longer recommended for healthy children and pregnant women. This announcement is traditionally determined by scientific experts rather than government officials.

The announcement follows an earlier Trump administration step to limit COVID-19 vaccinations among healthy people under age 65.

Previously, the United States followed recommendations from independent advisors to the Centers for Disease Control and Prevention, suggesting annual COVID-19 vaccinations for everyone over the age of 6 months.

Together, the moves have left health experts, vaccine makers and insurers uncertain about what to advise and what comes next.

“It’s going to add a lot of confusion overall,” said Ajay Sethi, an epidemiologist at the University of Wisconsin, Madison.

How can I get a COVID-19 shot for myself or my healthy child?

Some supply of this season’s vaccine remains available. Experts in the insurance field state that if individuals were covered before Kennedy’s announcement, it’s improbable that coverage would have ceased immediately after his public statement. Therefore, those who locate a vaccine dose are likely still able to receive it for now.

Will I still be able to choose a shot in the fall for myself or my child?

Who will be able to get what vaccines this fall is still unclear.

Vaccine manufacturers plan to issue updated COVID-19 shots in the late summer or fall. But the Food and Drug Administration has said it plans to limit approval of seasonal shots to seniors and others at high risk, pending more studies of everyone else.

Even if the U.S. approves vaccines only for certain groups, it still may be possible for others to get the shot depending on the outcome of upcoming advisory meetings, regulatory moves and decisions from insurers and employers.

Will my insurance still pay?

Insurers base coverage decisions on the recommendations of that CDC panel, the Advisory Committee on Immunization Practices. It’s not clear what role that panel now will play. Paying out of pocket could cost about $200.

But some insurers and employers may decide to still cover the shots regardless of the new recommendations, said Jen Kates, a senior vice president at the non-profit KFF, which studies health care issues. She noted that they may view the expense as worthwhile if it avoids a higher bill from someone hospitalized by the coronavirus.

What’s considered increased risk?

The FDA published a list of health conditions it said would qualify, including asthma, cancer, diabetes, obesity and physical inactivity. The CDC has a more extensive list.

But, again, it isn’t yet known how this will play out. For example, it could be hard for people to prove they’re qualified. If they’re vaccinated at a drugstore, for instance, the pharmacist wouldn’t normally know about underlying health problems or even ask. Kates said it’s unclear whether Kennedy’s move would affect whether doctors recommend the shot.

And Sethi, the UW-Madison expert, said “this elephant in the room” is that blocking vaccination to the healthy may mean people who have a risk factor and simply don’t know it will miss out.

Adding to the confusion, the FDA included pregnancy and recent pregnancy on the list of conditions that would qualify someone for a shot — but Kennedy said that pregnancy was no longer a qualification in his announcement this week.

COVID-19 complications during pregnancy can include preterm birth as well as serious illness in the mother, and the Society for Maternal-Fetal Medicine said it “strongly reaffirms” its recommendation for vaccination during pregnancy.

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The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group and the Robert Wood Johnson Foundation. The AP is solely responsible for all content.