Epidemiologist breaks down new restrictions on COVID shots

Amna Nawaz:

Many Americans who want to get the newest COVID vaccines may now have a harder time doing so after the Food and Drug Administration limited approval for the shots to adults 65 and older or those who are at high risk for severe disease. The vaccine was previously available to anyone 6 months and older.

People have questions and we're going to try to answer some of them now with Katelyn Jetelina, adjunct professor at the Yale School of Public Health and the author of the Substack column Your Local Epidemiologist.

Welcome back to the "News Hour." Thanks for joining us.

Katelyn Jetelina, Your Local Epidemiologist Substack:

Thanks for having me.

Amna Nawaz:

Let's just start with the basics here.

Right now, according to the FDA, who is eligible to get the COVID-19 vaccine?

Katelyn Jetelina:

That's right.

So FDA narrowed its label last week for COVID-19 vaccine to only people that are 65 and older and those 6 months through 64 years with at least one high-risk condition. This is a big departure from past years, and it is quite unusual for the FDA to restrict a vaccine this way.

Meanwhile, medical groups don't necessarily agree with the FDA label. Pediatricians, for example, recommend all kids under 2 get vaccinated, whether they have a high-risk condition or not, plus high-risk kids and those living with vulnerable family members.

And so, as you can imagine, this is starting to get confusing pretty quickly, because you can end up with scenarios where on one hand pediatricians say a healthy 1-year-old should get a COVID vaccine this fall because of their little vulnerable immune systems, but on the other hand FDA label says no.

And so that means, for some families, they could be pushed onto getting off-label COVID-19 vaccines this fall.

Amna Nawaz:

Just one more definitional question here. When you're talking about high-risk, what are we talking about? What does that include?

Katelyn Jetelina:

Yes, so FDA didn't spell this out last week, but they did defer to CDC's list. And this is good news because it's very broad. High-risk includes everything from pregnancy to those with diabetes or obesity and cancer, disabilities, or even mental health conditions.

And so, by some estimates, that covers nearly three-quarters of U.S. adults.

Amna Nawaz:

And as folks are trying to understand this change, I mean, you mentioned it's not typical for these kinds of policy changes to happen. There's disagreement in the medical community.

What is your understanding of what led to the change? Did something change with the vaccines or COVID itself?

Katelyn Jetelina:

Yes, so science hasn't changed, right? The vaccine is still effective at providing additional protection, and it's also safer than the virus itself.

What has changed is, one, the environment, right? Most of us now have some level of immunity. And our ICUs aren't overflowing. We're not in the middle of an emergency, which is great. And so on one hand it does make sense to prioritize pregnancy and kids under 2 and older adults, for example.

But the way this policy is being rolled out, it's out of order, it's inconsistent, it's very unclear, it's not transparent, has left a lot of pharmacies and physicians and families scrambling, mainly because RFK, our health and human services secretary, doesn't believe that this process was evidence-based, although it's been the process we have used for the past 90 years.

Amna Nawaz:

So you mentioned the pharmacy piece of it there. People have probably seen both CVS and Walgreens are now limiting access to the COVID vaccine in some states, requiring prescriptions in others.

If people want to get the shot, are they going to be able to get it through their local pharmacy, and is insurance going to cover it?

Katelyn Jetelina:

Yes, this is like the billion-dollar question, right? And this is critical, because 90 percent of COVID vaccines are given at pharmacies.

So, right now, two things are happening. One is, in about 16 states, pharmacies like CVS or Walgreens have paused COVID-19 vaccines altogether because their state's authority depends on very clear guidance, which we haven't really gotten from CDC. We were supposed to get it in June. It still hasn't come out yet, so those states are in limbo.

The second thing that's happening is that, in other states, pharmacies may still offer the vaccine, they may still have them in stock, but for people who only fit the FDA label. Pharmacists generally cannot give vaccines off-label. So if you're a healthy 40-year-old who wants to get the shot, you will probably be turned away from your pharmacy.

Insurance coverage is also in limbo. It's not entirely clear whether health insurance is going to cover the cost of your vaccine, and this uncertainty makes it very difficult for families who want to protect themselves.

Amna Nawaz:

So, a lot of questions, we don't yet have the answers to, it seems like.

But, as you mentioned, pretty much anyone 6 months and over could get the shot before this policy change, but we should also point out uptick of the vaccine has been very low among adults. CDC data showed that less than a quarter of adults received the shot last year. So, for most people, if you have the original shots, if you have got some boosters, if you have had COVID, should they still be getting the COVID vaccine?

Katelyn Jetelina:

What we're seeing is that the data is consistent that, if you get a COVID-19 vaccine, you have additional protection against COVID infection, albeit not perfect, but also severe disease, for at least four to six months after the vaccine.

It is getting really confusing. For my family, I'm going to still follow the evidence-based guidance from medical societies. I am young, but I also have a chronic condition. So I will still be getting this vaccine this fall. Also, the vaccines aren't the only tool we have in our tool box.

I'm sure people are really sick of the Swiss cheese model, but there's also other steps to take not to get sick, like wearing a mask in crowded indoor spaces, testing before you visit grandparents in the nursing home. There's many ways to balance risk at this moment.

Amna Nawaz:

If I ask you to take — kind of step back and look at the bigger picture right now, we saw last week Health and Human Services Secretary Robert F. Kennedy Jr. fire the CDC director, Dr. Susan Monarez.That also then led to the resignation of multiple other senior CDC officials, who all said they were concerned about his leadership, concerned about his stance on vaccines.

I just want to get your response to that as someone who tracks this very closely. What are your concerns? And are you worried about the CDC losing its credibility in this moment?

Katelyn Jetelina:

Last week was a huge week in public health, because, essentially, CDC imploded, right?

Like you said, the director and four senior leaders were basically — were pushed out. And these are not just bureaucrats. They were very steady hands who guided us through crises after crises with clarity, compassion, and were evidence-informed.

And when leaders like this are forced out, it is not just the agency that suffers. It is all of us, right? A weaker CDC means communities are more vulnerable, from outbreaks, to chronic diseases, to even basic health data. The foundation of public health is eroding faster than I ever thought possible.

And I don't say this lightly, but if we do not change the ship's direction, I truly think our nation's health security is at risk.

Amna Nawaz:

Katelyn Jetelina, author of the Substack column Your Local Epidemiologist, always good to speak with you. Thank you.

Katelyn Jetelina:

Thanks for having me.