The first deployment of updated Covid shots under the Trump administration has been plagued by access issues and misinformation amid confusion and chaos at US health agencies.
People attempting to get the vaccines say they have struggled to understand eligibility requirements, book appointments, process insurance claims, battle misinformation from pharmacists and obtain prescriptions from their doctors in some states. Such hurdles will disproportionately affect people of color and low-income people, experts say.
These problems come amid turmoil at US health agencies, with top leaders of the Centers for Disease Control and Prevention (CDC) quitting because of reported pressure from the Trump administration to approve unscientific vaccine policies and new limitations placed on the Covid vaccines.
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“Anybody can get the booster,” Robert F Kennedy Jr, secretary of the US Department of Health and Human Services (HHS), said at a hearing before a US Senate committee last week – before adding: “It’s not recommended for healthy people.” In an August post on X, Kennedy said the updated Covid vaccine was approved only for people “at higher risk”.
Matt Shipman, a health writer in North Carolina, was eager to receive an updated shot to protect himself against the acute and long-term risks of a Covid infection, especially as the late-summer Covid wave appears to be reaching its peak.
It used to be easy to schedule an appointment at a pharmacy, but now he received a message saying the vaccines will hopefully be available in a few weeks. He had heard some people were getting prescriptions for the shots, but when he called his doctor’s office, they wouldn’t even make an appointment for a prescription.
North Carolina is one of several states where pharmacists are requiring prescriptions before administering any shots.
In some states, pharmacists are prevented by law from administering vaccines that are not recommended by the CDC’s advisory committee on immunization practices (ACIP). While doctors have liability protections for Covid vaccines under the Public Readiness and Emergency Preparedness (Prep) Act, pharmacists may not if the vaccines are not approved by the advisory committee.
Some insurers might also opt not to cover the shots until they are recommended.
The independent advisers are expected to take up Covid recommendations at the next meeting in mid-September, but that meeting has been embroiled in controversy. Senator Bill Cassidy, a Republican from Louisiana, called for an indefinite postponement given the recent upheaval at health agencies.
Shipman said: “It’s incredibly frustrating, because this has significant consequences for public health, and there is no reason in the world for this to be happening.
“It is an entirely manufactured problem that is going to cost people their health and wellbeing and possibly their lives. It is manifestly clear that people who would like the Covid vaccine are not able to access it.”
Changing the rules to make vaccination easier will depend on the state, said Lindsay Wiley, a professor of law and faculty director of the health law and policy program at UCLA Law.
“In several states, governors and health officials are solving the prescription problem pretty swiftly, so it’s a rapidly evolving situation right now. In other states, the legislature may need to take action to fix the problem,” Wiley said.
Even states that have tried to combat the confusion still have vaccine challenges. The state of Maryland released guidance last week for all residents to access vaccines – without specifying the need to disclose qualifying conditions. Maryland’s governor, Wes Moore, called the federal changes to vaccine policy “harmful for Marylanders and all Americans”.
Yet when Ian Morgan tried to obtain the vaccine in Maryland, the pharmacist said it could only be administered to those over the age of 65 or people with at least one underlying health condition. Morgan tried to make an appointment online, but was told CVS couldn’t schedule his appointment because he did not qualify.
Morgan, a postdoctoral fellow at the National Institutes of Health and a union steward of NIH Fellows United-UAW 2750, said the tumult has been caused by Kennedy’s messaging on vaccines.
“I think the chaos is the point, and that chaos has consequences,” Morgan said. “Creating this confusion, creating this chaos, trying to discredit scientific experts – and we see that every time [Kennedy] goes out there – that in and of itself is causing problems, and that in itself is harming the American people.”
Morgan is one of 1,000 current and former HHS employees who signed a letter calling for Kennedy’s resignation.
Vaccine availability for children, especially for those under the age of five, has lagged even further behind adults as pediatricians struggle to understand new limitations and potential legal risks.
Joanne Hilden, a retired physician, has been searching for the updated vaccines for her four grandchildren, who are between the ages three and 12, in Minnesota. The local health department, where the youngest two kids were vaccinated in 2021, is only offering vaccines for adults over the age of 65. Pharmacies have not received the pediatric doses yet.
There are also immense structural barriers that make it harder for marginalized people to access the shots.
Julia Lynch, a professor of political science at the University of Pennsylvania, first made plans to get vaccinated in Oakland, New Jersey, a 45-minute drive from her home in Philadelphia, before the state board of pharmacy gave pharmacies the go-ahead to vaccinate Pennsylvanians.
The CVS pharmacies near her home had no appointments, so she ended up driving to a predominantly white suburb.
“I don’t know why it is that the vaccines are getting to those CVSes first,” she said. But that means “if you’re Black or Latino, you are less likely than if you’re white to live close to someplace where you can get a vaccine”.
The population of Oakland, for example, is 80% white and had appointments – but neighboring Camden, New Jersey, had no appointments, and its population is 3.5% white.
Transportation is another major issue. Traveling to Oakland by public transit would have taken more than two hours on three buses and one regional train.
“Eligibility right now is obviously limited to people who are over 65 or who have at least one medical condition that puts them at high risk,” Lynch said. “These are exactly the people who are most likely to have trouble traveling four-plus hours on a multimodal public transit journey to get their Covid shot.”
Not everyone has reliable internet access, the technological knowledge to book appointments, or the ability to take time off work or find childcare to locate and travel to appointments.
“For people who are not chronically online, it’s a major undertaking to do all this,” Lynch said.
Fighting to have the shots covered by insurance, or paying out of pocket for the uninsured, is another major hurdle, she said.
Rachel, who lives in Pittsburgh and asked to be identified by her first name to protect her health history, has two autoimmune disorders and a genetic blood clotting disorder that puts her at high risk if she gets sick with Covid. She said she would like to get the latest Covid shot, but is planning to wait for a few weeks.
“The challenges right now for me are just around information, and actually knowing what is the truth and what is going to happen if I try to get it,” she said. She said she had heard of people being turned away from pharmacies even after the Pennsylvania vaccine announcement.
“It just sounds like it’s still a shitshow. It’s still challenging to make an appointment here, so I’m going to wait a little bit.”
Rachel said it reminded her of 2021, when many people scrambled to get their first Covid shots.
“It’s just frustrating to me that based on absolutely zero evidence, and in some cases, just making up lies about evidence, [the] HHS has just decided these are so dangerous that we need to limit them,” she said.
Sarah, who lives in Westchester county, New York, and asked to be identified by her first name so she is not harassed by anti-vaccine activists, said she was finally able to get the shot after days of effort.
In New York, she needed a prescription. That later changed when Kathy Hochul, the governor, opened up access to all New Yorkers.
The faxed prescription never went through, so her health system had to set up an electronic prescription system. Sarah asked that her doctor prescribe any Covid vaccine; she said she overheard the pharmacist denying one prescription because it was for the Pfizer vaccine and they only had Moderna.
Even after the prescription was received, the pharmacist said he needed verbal confirmation from the doctor by phone as well.
Sarah said she paid $250 out of pocket, and has since spent hours on the phone with her insurance company to be reimbursed. After she paid, the pharmacist tried to dissuade her from getting the shot, Sarah said.
“Do you really know what you’re getting into? This is brand new,” she recalls him saying. She responded: “I know – that’s why I want it.” But he told her they “don’t know anything” about the updated vaccines and “we don’t know what’s gonna happen” to her once she received it, she said.
The roadblocks were “wearing me down”, Sarah said. “It’s trying to make it inaccessible, impossible, confusing.”
Shipman in North Carolina was dogged in his search, even looking at appointments in other states. Eventually, he was able to receive the vaccine at an urgent care center.
But not everyone is able to track down the vaccine and overcome these obstacles, Lynch said. “It’s really hard for ordinary people who are very busy and not necessarily paying close attention to this to know what they’re supposed to do to keep themselves or their loved ones safe.”
