The upcoming fall and winter months are about to bring the usual crop of respiratory illnesses—influenza, respiratory syncytial virus (RSV) and, of course, COVID. But this will be the first time since COVID vaccines were developed that many people in the U.S. will not have easy access to immunization against SARS-CoV-2, the virus that causes the disease, which has contributed to the deaths of more than 1.2 million Americans to date.
Public health experts had nervously tracked U.S. health agencies’ actions on vaccines in general and COVID vaccines in particular since February, when longtime antivaccine activist Robert F. Kennedy, Jr., took the reins of the Department of Health and Human Services. Conflicting messaging and ambiguous guidance from the Centers for Disease Control and Prevention and the Food and Drug Administration shook up the usual launch of annual vaccines.
“We typically have this very clear set of dominoes for a vaccine rollout: it’s smooth; it’s synchronized; it’s sequenced,” says Katelyn Jetelina, an epidemiologist and founder of the newsletter Your Local Epidemiologist. “But we have these missing or wobbling dominoes right now, and so the rest of the chain is backed up.”
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On August 27, one of those dominoes fell when Kennedy announced in a post on X that the FDA had approved the updated COVID vaccines only for adults aged 65 or older and those with underlying health conditions that increase risk of severe infection. The decision leaves healthy children and adults without easy access; they may be limited to receiving vaccines at physicians’ offices instead of pharmacies, and health insurance might not cover the full cost for everyone.
Scientific American spoke with experts about what the public can expect in terms of COVID vaccines this fall.
COVID Cases Are Rising Again
All signs suggest that COVID cases in the U.S. are ticking up. Wastewater surveillance showed moderate, high and very high levels of SARS-CoV-2 in much of the nation, as of the week ending on August 9. Rates of positive COVID tests and emergency department visits were also up as of the week ending August 16. All three measurements are early indicators of increased viral prevalence.
Although COVID death rates are currently low, they will likely rise on a delay from those early indicators. Regardless, SARS-CoV-2 continues to take lives: More than 100 people in the U.S. have died of COVID every single week of this year, according to the CDC. Similarly, rates of new long COVID diagnoses have slowed since the early days of the pandemic, but new infections continue to trigger the lingering and disabling syndrome.
Assessing COVID’s current risks is a tricky balance, says David Higgins, a pediatrician and vaccine delivery specialist at the University of Colorado School of Medicine. “We are clearly in a different place than we were in 2020 and 2021, and that is a good thing,” he says. “At the same time, I think the fact that we are in such a different place can maybe lead some people to underappreciate that COVID is still causing harm for many people.”
What COVID Vaccines Are Available This Year?
Three manufacturers have produced COVID vaccines this year: Moderna and Pfizer have made mRNA vaccines and Novavax has made a protein-based shot. The two mRNA manufacturers, at least, tailored their vaccines to the LP.8.1 variant, the version of the COVID-causing virus that was increasing in prevalence when vaccine scientists decided which version to target this year.
As of the week ending on August 9, a newer variant called XFG represented 65 percent of infections. XFG and LP.8.1 are both members of the JN.1 family, which arose at the end of 2023. Experts expect this year’s formula to shield against XFG, although the exact degree of protection is always difficult to predict at the beginning of the season.
Why Is COVID Vaccine Access Changing?
COVID vaccines go through two separate federal government procedures that determine who can access them and how they can do so. This year neither process has gone particularly smoothly.
One system is the CDC’s Advisory Committee on Immunization Practices (ACIP), which makes recommendations for who should receive which vaccines. This procedure governs access because insurance companies must fully cover the costs of recommended vaccines, according to the Affordable Care Act.
Earlier this year Kennedy removed all existing members from the panel and appointed new ones—a highly unusual and criticized move—shortly before the scheduled June meeting. At that gathering, the committee was supposed to decide on this year’s COVID vaccine recommendations, but the replacement members declined to vote. It’s unclear when ACIP will meet next. The CDC’s website references a meeting that will occur in August or September but notes “dates TBD”; the next formally scheduled meeting is slated for October 22.
The other system is the FDA’s labeling process, which recently decided on access for healthy children and adults. This influences how vaccines are given. Agency personnel inspect the vaccines, ensure they are safe and outline prescribing guidelines for health care providers. This process matters because pharmacists are generally not allowed to administer vaccines outside of what the label permits—typically only doctors can provide vaccines “off-label.”
Generally, pharmacists are unable to administer vaccines off-label, which means that healthy adults who want a vaccine will have to visit a physician’s office. That’s a big change, Jetelina says, given that some 90 percent of the public got their COVID shots from a pharmacist last year.
Will 2025 COVID Vaccines Be Free and Covered by Insurance?
Costs are key to watch as events unfold. Assuming ACIP’s recommendations change to match the FDA’s new limitations, it’s not yet clear whether insurers will pass some or all of the cost—about $140 per COVID shot for adults—to consumers.
Experts say that insurers may decide to cover the vaccines even if requirements change because the cost of a vaccine pales in comparison with the cost of treatment for someone with a serious infection. But that’s not guaranteed. America’s Health Insurance Plans, the trade organization for private health insurers, has said it supports “broad access to critical preventive services,” but experts worry that approach could still require some level of co-pay.
“If you start charging people for vaccines if they’re off-label, it’s going to really impact uptake,” Jetelina says.
Who Can Get a 2025 COVID Vaccine, and How Can They Do So?
People Aged 65 or Older
This age group should be able to get the shot for free at a pharmacy, with no known changes from last year.
Newborns
Babies under the age of six months have never been able to receive COVID vaccines. During this period, they rely on immunity transmitted to them during gestation.
Pregnant People
The bottom line: You may need to get vaccinated at a doctor’s office. And you may face a co-pay.
The details: Earlier this year the CDC (independently of ACIP) removed its recommendation that pregnant people be vaccinated against COVID despite evidence in this population proving both that the vaccine is safe for them and that they experience higher rates of serious disease when infected. That move means pregnant people will need to receive the vaccine off-label, likely at a doctor’s office rather than a pharmacy.
The American College of Obstetricians and Gynecologists, the leading professional group for these practitioners, recommends people receive an updated vaccine at any point during pregnancy or while breastfeeding and notes that the vaccines are very safe and effective for these populations. This move supports doctors with additional authority when providing care that goes against the current administration’s priorities.
Adults Aged 18 to 64 with Underlying Health Conditions
The bottom line: You may be able to get vaccinated fairly easily and with full insurance coverage—with one big catch.
The details: COVID vaccine access has been preserved for adults with underlying conditions that put them at higher risk of serious disease. And Jetelina says that it appears that a preexisting list of qualifying conditions by the CDC is going to be used, at least for now.
That CDC list is quite broad and includes not just diagnosed illnesses but also lifestyle factors—such as physical inactivity and current or previous smoking. The list also includes pregnancy.
Additionally, it’s not yet clear how people who meet health-based qualifications will access the vaccine. Jacinda Abdul-Mutakabbir, an associate professor of clinical pharmacy at the University of California, San Diego, hopes people with an underlying risk factor will be able to simply tell a pharmacist about their condition to receive a vaccine, as is the case for the RSV vaccine among adults who are 50 to 64 years old. Jetelina says another potential scenario is that pharmacists might require that such individuals sign paperwork attesting to their risk factors to receive a COVID vaccine. But these possibilities will remain speculation until the government provides more details.
Children with Underlying Health Conditions
You should be able to vaccinate your child. Insurance should cover it. As with adults, it is not yet clear what health conditions will qualify children to receive a vaccine, however.
Healthy Children
The bottom line: Ask your pediatrician to vaccinate your child. Insurance may cover it.
The details: Earlier this year the CDC (independently of ACIP) changed its COVID vaccine recommendation to state that children aged six months or older can receive the shot based on “shared clinical decision-making.” That’s a technical phrase used to indicate that widespread benefit is unclear but that a vaccine can be beneficial for some people, who should be able to get it. Vaccines with this indication should still be fully covered by both private insurance and the Vaccines for Children program, for which half of U.S. children are eligible.
The American Academy of Pediatrics (AAP), the leading professional group for pediatricians, has already produced its own vaccine guidelines that say children between six and 23 months of age, as well as children who are immunocompromised, are at high risk of severe COVID and should be vaccinated. In addition, the group states that children whose parents wish them to receive a vaccine should be able to get one. This stance should encourage doctors to provide the vaccine off-label despite federal policy changes, Jetelina says.
Additionally, the FDA has pulled authorization for Pfizer’s vaccine for children under age five. This move could potentially shift more demand onto Moderna’s vaccine, which can be given to those aged six months or older.
Healthy Adults
The bottom line: You may be able to get a vaccine. But you will likely need to visit a doctor’s office to get it, and insurance may not fully cover the cost.
The details: Plan to consult with your primary care provider about accessing a COVID vaccine this fall off-label, Jetelina says.
Albert Shaw, a professor of medicine at the section of infectious diseases at the Yale School of Medicine, is particularly worried about healthy adults who work in health care; vaccine access for this group may be overlooked. In terms of public health, that’s a big problem: Health care workers are exposed to higher levels of disease in general. And if they catch an infection, even if it’s mild for them, they risk transmitting it to patients who may be more vulnerable.
How Can I Keep Myself and My Family Healthy This Year?
Ask providers directly for a COVID vaccine: Call your primary care provider to ask whether they will have vaccines available this fall and whether you are eligible to receive one. If they won’t be offering them, ask for their advice on where you can get vaccinated.
Be prepared to skip the pharmacy: Your doctor may be better able to navigate labeling changes with you. Also, keep an eye out for local and state initiatives that may attempt to distribute COVID vaccines despite the federal landscape.
Understand health care costs and coverage: Call your insurance company and ask that they fully cover COVID vaccines. Watch for statements and other communication from your health insurance provider about what will be covered or what, if any, co-pay will be required.
Get other vaccines for yourself and your children: Abdul-Mutakabbir notes that the vaccines for flu and RSV have so far been unaffected by the administration’s antivaccine efforts. “The more that we can decrease the burden of the respiratory viral season, the better everybody is,” she says. Influenza was particularly serious last year, especially for children.
Take general measures to reduce viral transmission: Proper handwashing remains a valuable public health measure. You can also wear a high-quality mask for additional protection. If you feel unwell and can do so, stay home to avoid spreading any germs. If you have children, teach them to cover their mouth when they cough or sneeze.
Why Get a COVID Vaccine?
No medical intervention is either completely effective or completely safe, but countless analyses show that COVID vaccines, like all available vaccines, are extremely safe and make a real difference in people’s health. “Overall, they have an excellent safety record,” Shaw says of the COVID vaccines.
Most reported side effects of the COVID vaccines are mild and transient, such as fever, chills, headache, muscle pain and nausea. Occasional serious allergic reactions to these vaccines can trigger breathing problems, throat swelling, a fast heartbeat and hives, but these issues are quite rare: one 2021 study of the Pfizer COVID vaccine found just 11 cases of severe allergy per million doses administered.
One side effect of the mRNA COVID vaccines has been most common in boys and men from age 12 to 39 and involves cardiovascular issues that are caused by inflammation in the heart and the lining surrounding it. This complication is very rare, however: it has occurred in the range of 50 to 100 young male individuals per million doses, depending on their age subset, according to one study. Importantly, the same heart issues can also be a side effect of COVID infection.
“On balance, when you see the benefits that vaccines are offering and then their risks, the benefits still outweigh the risk,” says Ziyad Al-Ali, a clinical epidemiologist at the Washington University in St. Louis.
Last year’s COVID vaccines were 33 percent effective at reducing emergency department and urgent care visits in adults compared with people who hadn’t gotten a dose, with higher rates of effectiveness for older adults and people with weaker immune systems. (Although 33 percent may not sound very effective, that effectiveness rate is on the magnitude of 10,000 times higher than the risk of vaccine side effects mentioned above.)
And any COVID infection could potentially lead to long COVID. People are still developing the condition even now—including otherwise healthy adults and children, Al-Aly notes. “Anybody is at risk of long COVID,” Al-Aly says. “Long COVID really does not discriminate.” Because the condition only arises after a COVID infection, it’s not surprising that reducing infections through vaccination has been proven to reduce the occurrence of long COVID.
Despite these threats, only 23 percent of adults in the U.S. reported receiving last year’s vaccine dose when it was recommended to everyone aged six months or older. Just 13 percent of children between six months and 17 years of age were reported to have been vaccinated.
And health experts warn that reducing access to vaccines will make those numbers fall even further—leading to real consequences for real people. “People will get sick,” Al-Aly says. “Some of that sickness and suffering could be avoided with proper mitigators that we are deliberately choosing to abandon.”