More than three-quarters of American adults didn’t get a COVID shot last season, a figure that health care experts warn could rise this year amid new U.S. government recommendations.

The COVID vaccine was initially popular. About 75% of Americans had received at least one dose of the first versions of the vaccine by early 2022, Centers for Disease Control and Prevention data shows. But only about 23% of American adults got a COVID shot during the 2024-25 virus season, well below the 47% of American adults who got a flu shot. The vaccination rates for flu, measles and tetanus are also going down.

Yet COVID remains a serious, potentially deadly health risk, listed as the primary cause of death on roughly 31,400 death certificates last year. By comparison, flu killed about 6,500 people and pneumonia, a common complication of the flu, killed an additional 41,600, CDC data shows.

As millions of Americans decide whether to get a COVID shot this season, public health researchers worry vaccination rates will slide further, especially because Hispanic and Black Americans and those under 30 have lower rates, exposing them to serious complications such as long COVID. Under the Trump administration and Health and Human Services Secretary Robert F. Kennedy Jr., the federal government has narrowed its recommendations on the COVID vaccine, leading to a hodgepodge of rules on pharmacy access, with Americans living in Republican states often facing more barriers to getting a shot.

“A lot of misinformation is going around regarding COVID,” said Alein Haro-Ramos, an assistant professor of health, society, and behavior at the University of California-Irvine. “Vaccine hesitancy is going to increase.”

In August, the FDA narrowed approval for COVID vaccines to those 65 or older and to adults and children with at least one underlying condition that puts them at high risk for serious complications from COVID.

A month later, the CDC’s Advisory Committee on Immunization Practices voted to recommend “shared clinical decision-making” on the vaccine, pulling back from advising all adults to get vaccinated. The committee advised doctors to emphasize to adults under 65 and children that the benefits of the vaccine are greatest for those with underlying health conditions.

The guidance is rebutted by infectious disease experts who say most adults and children should get both the flu and COVID vaccines, which are safe, effective, and prevent serious illness. Several independent medical organizations like the American Academy of Family Physicians and the American Academy of Pediatrics have reiterated their support for broad adoption of COVID vaccines.

More than two dozen states have taken steps to ensure most people can get a COVID shot at the pharmacy without a prescription, with many states tying their policies to the advice given by medical organizations. And many of those states require insurers to cover vaccines at no cost, according to a KFF analysis. In several other states, predominantly Republican-led, pharmacy access to vaccines may require a prescription.

Among the most commonly cited reasons for COVID vaccine hesitation are fears about side effects, long-term health consequences, and the effectiveness of the vaccine, and mistrust of pharmaceutical corporations and government officials, according to a 2024 review of multiple studies, published in the journal Vaccines.

COVID vaccine hesitancy in the 2024-25 virus season was higher among Latinos, African Americans, men, uninsured people, and people living in Republican-leaning states, CDC data shows.

Latino adults were significantly less likely than adults from most other racial and ethnic groups to get a COVID shot last season, with a vaccination rate around 15%.

Some of that may be due to age: A disproportionate share of Latinos are young. But public policy actions may also be a factor. The first Trump administration, for example, tied Medicaid to “public charge,” a rule allowing the federal government to deny an immigrant a green card or visa based on their dependence on taxpayer-funded programs. Some Latinos may be afraid to sign up for social services even after the Biden administration reversed those first-term Trump actions.

Haro-Ramos co-authored a study published in 2024 that found many Latinos were hesitant to get vaccinated because of fears about their immigration status, and that experiencing health discrimination, like care denials or delays, increased their vaccine hesitancy.

“Do you trust the health care system, broadly speaking? Do you want to provide your information — your name, your address?” Haro-Ramos said. “Trust is critical.”

Haro-Ramos said the problem has likely worsened since her study was published. The Trump administration revealed this summer that it would give the personal information of Medicaid enrollees to Immigration and Customs Enforcement. Many Latinos are canceling doctor appointments to head off possible confrontation with immigration enforcement officials.

“People are avoiding leaving their homes at all costs,” Haro-Ramos said.

Janani Rajbhandari-Thapa, an associate professor at the University of Georgia College of Public Health, recently co-authored a study of COVID vaccination among nearly 1,500 African Americans living in south Georgia. The study found that participants were more likely to listen to their health care providers than faith leaders or co-workers when seeking advice on getting vaccinated.

More than 90% of those studied had received at least one dose of the vaccine, but those who were unvaccinated were more likely to agree with false statements that tied vaccines to miscarriages, to components’ remaining in the body for a long time, or even to the conspiracy that they implant a computer chip in the body.

“It’s the clinicians who can take the messages about vaccination — that these are myths,” Rajbhandari-Thapa said.

Even though COVID hospitalization and death rates have fallen dramatically since the worst days of the pandemic, fatal complications related to COVID remain most common among older people. Around 89% of U.S. COVID deaths last year were among people 65 and older, compared with about 81% of flu and pneumonia deaths.

As the pandemic falls into the rearview, young people have developed a sense of invincibility. Only 11% of Americans ages 18 to 29 received a vaccine during the 2024-25 virus season, the lowest vaccination rate among adult age groups. That’s far below the 70% of young adults who got at least one dose of the initial COVID vaccines by November 2023.

While many people get COVID after receiving a COVID shot, because the vaccine’s ability to prevent infection wears off pretty fast, some misunderstand the purpose of the shot, said Otto Yang, an infectious disease specialist at UCLA Health.

“They think, ‘Well, the vaccine didn’t prevent me from getting COVID, so the vaccine didn’t work,’” Yang said. “And what they’re not seeing is that the vaccine prevented them from getting severely ill, which is ultimately the most important thing.”

And the vaccine can help prevent long COVID, which is a problem for all ages, Yang said. A recent Northwestern University study found that younger adults suffer worse symptoms of long COVID than older adults.

Ultimately, Yang said, it is not a consistent choice to get a flu vaccine but forgo a COVID vaccine, since both are safe, effective, and prevent serious illness. It is clear, he added, that people with compromised immune systems and those at higher risk should get a COVID shot. The decision is “a little bit less clear” for others, but “probably most adults should be getting vaccinated, just like it’s recommended for the flu vaccine, as well as most children.”

Phillip Reese is a data reporting specialist and an associate professor of journalism at California State University-Sacramento.

©2025 KFF Health News. Distributed by Tribune Content Agency, LLC.

A large study from Massachusetts has found that babies whose mothers had COVID-19 while pregnant were slightly more likely to have a range of neurodevelopmental diagnoses by age 3. Most of these children had speech or motor delays, and the link was strongest in boys and when the mother was infected late in pregnancy.

The increase in risk was small for any one child, but because millions of women were pregnant during the pandemic, even a small increase matters. The study doesn’t prove that COVID infection during pregnancy causes autism or other brain conditions in the fetus, but it suggests that infections and inflammation during pregnancy can affect how a baby’s brain grows, something scientists have seen before with other illnesses. It’s a reason to help pregnant women avoid COVID and to keep a close eye on children who were exposed in the womb.

What the study found

Researchers at Massachusetts General Hospital examined medical records from more than 18,000 mothers and their children born from March 2020 through May 2021, before vaccines were widely available to pregnant women. Because everyone giving birth during that period was tested for COVID, the team could clearly see which pregnancies were exposed to the virus causing it.

About 5% of those mothers had COVID while pregnant. Their children were modestly more likely to be diagnosed with a neurodevelopmental condition by age 3 than those whose mothers weren’t infected, even after accounting for differences in maternal age, race, insurance status, and preterm birth.

The link appeared strongest among boys and when infection occurred in their mother’s third trimester. Still, most children in both groups showed typical development.

“This was a very clean group to follow,” said Andrea Edlow, a maternal-fetal medicine specialist at Mass General and one of the study’s authors. “Because of universal testing early in the pandemic, we knew who had COVID and who didn’t.”

Independent authorities say COVID, which causes a powerful immune response in some people, fits the biological pattern seen with other infections in pregnancy. Alan Brown, a professor of psychiatry and epidemiology at Columbia University who studies maternal infection and brain development and was not involved in this research, explained, “COVID would be a very strong candidate for it to happen because the amount of inflammation is very extreme.”

How might infection affect brain development?

Scientists are still piecing together how various infections during pregnancy can affect fetal development. Severe illness can cause inflammation that disrupts brain growth or can trigger preterm birth, which carries its own risks.

“There’s a long history of evidence showing that maternal infection can slightly raise the risk for many neurodevelopmental disorders,” said Roy Perlis, the vice chair for research in psychiatry at Massachusetts General Hospital and co-author of the new study.

Edlow’s lab is investigating how infection and inflammation may interfere with brain development. In a healthy brain, immune cells help shape developing neural circuits by trimming away extra or unnecessary connections, a process known as “synaptic pruning,” which sculpts the brain’s wiring. When a mother’s immune system is activated by infection, inflammatory molecules can reach the fetal brain and alter the pruning process.

Animal studies support Edlow’s hypothesis. When scientists trigger inflammation in pregnant mice, their offspring often show changes in how brain cells grow and connect, changes that can alter learning and behavior.

Why late pregnancy and why boys?

In Edlow and Perlis’ study, the link between COVID and developmental delays was strongest when infection occurred late in pregnancy, during the third trimester. That’s also when the fetal brain is growing most rapidly, forming and refining millions of neural connections.

“When we think of organ development, we think earlier in pregnancy, but the brain is an exception in this regard, where there’s a massive amount of brain development in the third trimester. And that continues after birth,” Perlis said. “It is entirely plausible that the third trimester is a period of vulnerability specifically for brain development.”

But not all researchers agree that the third trimester is uniquely vulnerable. Brian Lee, a professor of epidemiology at Drexel University, cautioned that because most mothers in the study were tested at delivery, there were simply more late-pregnancy infections to analyze. “That gives the study more power to find a difference in the third trimester,” he said. “It doesn’t prove earlier infections aren’t important.”

The study also found stronger effects in boys. That pattern is familiar: Boys are generally more likely than girls to have speech or motor delays and to be diagnosed with autism. Researchers suspect that male fetuses may be more susceptible to stress and inflammation, though the biology isn’t fully understood.

What the study can and can’t show

Edlow and Perlis are careful to say the study shows an association, not proof that COVID infection in pregnancy causes developmental problems. Many other factors could explain the correlation.

Mothers who get sick with COVID may have other health issues, such as obesity, diabetes, or mental health conditions, that increase the risk of developmental delays in children. “Persons with mental disorders are much more likely to get COVID. Women with mental disorders are much more likely to have kids with neurodevelopmental problems,” Lee said. “Mothers with worse physical health are also at higher risk of having children with neurodevelopmental problems.”

Lee’s research has shown that even infections before or after pregnancy can be linked to autism, suggesting that shared genetics or environment, rather than the infection itself, could be at play. That’s why experts say much larger, longer studies are needed to understand the extent of any risk from the infection.

Edlow, Perlis, and their team plan to follow the children in their study as they grow older to see whether early differences persist or fade. They’re also studying how inflammation during pregnancy affects the placenta and fetal brain, and how to counteract these effects.

What about vaccination?

Because this study followed pregnancies from early in the pandemic, it doesn’t answer whether vaccination changes the risk. But other research offers reassurance.

A large national study in Scotland found no difference in early developmental outcomes between children whose mothers were vaccinated and those who weren’t. Another study in the U.S. found the same: no link between prenatal COVID vaccination and developmental delays through 18 months. Both align with decades of data showing that vaccination during pregnancy is safe for both the mother and the baby.

“Vaccination is a short spike … your immune system revs up, then it goes back to normal,” Edlow said. “COVID [infection] is much more prolonged, unpredictable, and people can get … a dysregulated immune phenomenon that really doesn’t exist in vaccine responses.”

What this means for parents and clinicians

Since late 2020, there’s been widespread confusion and misinformation about the safety of COVID vaccination during pregnancy. Some women have hesitated to get vaccinated out of fear it might harm their baby. But the evidence since then has been clear: COVID vaccines are safe in pregnancy. The American College of Obstetricians and Gynecologists strongly recommends COVID vaccination to protect both mother and child.

Experts say the broader lesson is that pregnancy is a period of vulnerability, and prevention matters, not only for COVID, but other infections as well.

Janet Currie, a professor of economics at Yale University, said these risks remain “underappreciated,” despite decades of evidence. “Even though the flu vaccine is recommended for pregnant women, very few pregnant women get it,” she said. “Physicians seem to be reluctant to vaccinate pregnant women.”

As Gil Mor, scientific director of the C.S. Mott Center for Human Growth and Development at Wayne State University in Detroit, put it, “Protecting the mother is protecting the long-term health of the offspring. … The best intervention is vaccination.”

A century-old echo

The idea that what happens in the womb can shape life after birth took root with studies of famine, like the Dutch “Hunger Winter” in the final months of World War II. In 1944 and 1945, as German forces blockaded the western Netherlands, rations fell to just a few hundred calories a day. Thousands died of starvation, and women pregnant during that period gave birth to babies who later faced higher risks of heart disease, diabetes, and schizophrenia. The episode became a cornerstone of the “fetal origins” idea, that deprivation or stress in pregnancy can have lifelong effects.

The 1918 flu pandemic broadened that idea to infection. Babies exposed to influenza in utero later showed small but lasting differences in education and earnings, a sign that illness during pregnancy could affect brain development. Researchers in Taiwan, Sweden, Switzerland, Brazil, and Japan found similar consequences. Some argued that those findings reflected the disruptions of World War I, not the flu itself. But later studies, including those from the United Kingdom and Finland, have strengthened the case for a biological effect, reinforcing that the infection itself, not wartime upheaval, was the key driver.

“It isn’t simply influenza that can alter fetal neurodevelopment,” Kristina Adams Waldorf, a professor of obstetrics and gynecology at the University of Washington, explained. “Many types of infections … in the mother can be transmitted as a signal to the fetus, which can alter its brain development.”

A century later, the same question has returned with COVID: Could infection during pregnancy subtly shape how children grow and learn? The new Massachusetts General Hospital study offers an early look at an answer.

©2025 KFF Health News. Distributed by Tribune Content Agency, LLC.

NEW YORK (AP) — Health Secretary Robert F. Kennedy Jr.’s new vaccine advisory committee meets this week, with votes expected on whether to change recommendations on shots against COVID-19, hepatitis B and chickenpox.

The exact questions to be voted on Thursday and Friday in Atlanta are unclear. Officials at the Department of Health and Human Services did not immediately respond to questions seeking details to a newly posted agenda.

But some public health experts are worried that the votes will — at a minimum — raise unwarranted new questions about vaccines in the minds of parents.

Perhaps even more consequential would be a vote that restricts a government program from paying for vaccines for low-income families.

“I’m tightening my seat belt,” said Dr. William Schaffner, a Vanderbilt University vaccines expert.

The panel, the Advisory Committee on Immunization Practices, makes recommendations to the director of the Centers for Disease Control and Prevention on how already-approved vaccines should be used. CDC directors have almost always accepted those recommendations, which are widely heeded by doctors and guide vaccination programs.

Kennedy, a leading antivaccine activist before becoming the nation’s top health official, fired the entire 17-member panel earlier this year and replaced it with a group that includes several anti-vaccine voices.

Here’s a look at the three vaccines being discussed:

COVID-19

Before Kennedy was health secretary, ACIP would typically vote in June to reaffirm recommendations for shots against respiratory viruses that sicken millions of Americans each fall and winter.

This past June, Kennedy’s ACIP voted to recommend flu shots for Americans but was silent on COVID-19 shots.

Before that meeting, Kennedy announced he was removing COVID-19 shots from the CDC’s recommendations for healthy children and pregnant women. The move was heavily criticized by doctors’ groups and public health organizations, and prompted a lawsuit by the American Academy of Pediatrics and other groups.

Days after Kennedy’s announcement, CDC officials said families could still get the 2024-2025 version of COVID-19 shots for their kids in consultation with their doctors. That clarification meant shots would still be covered by the federal government’s Vaccines For Children program, which pays for shots for families who lack money or adequate health insurance coverage. It’s now responsible for roughly half of childhood vaccinations in the U.S. each year.

As with flu shots, however, there are new COVID-19 formulations each fall, to account for changes in which strains are circulating. The committee has not yet voted on whether to recommend this season’s COVID-19 shots or whether those shots should be covered by the VFC program.

Further complicating the picture: When the FDA last month licensed this fall’s COVID-19 shots, the agency took the unusual step of narrowing their use for healthy younger adults and children.

If the ACIP simply follows that, and if there is no additional clarifying language from the CDC, then “that would take away access for roughly half of America’s kids,” said Dr. Sean O’Leary of the American Academy of Pediatrics.

The pediatricians group urges that vaccinations continue for all children ages 6 months to 2 years.

Hepatitis B

Hepatitis B can cause serious liver infections. In adults, the virus is spread through sex or through sharing needles during use injection-drug use.

But the virus also can be passed to a baby from an infected mother, and as many as 90% of infected infants go on to have chronic infections.

A hepatitis B vaccine was first licensed in the U.S. in 1981. In 1991, the ACIP recommended a dose within 24 hours of birth for all medically stable infants who weigh at least 4.4 pounds.

Infant vaccinations are stressed for women who have hepatitis B or, crucially, who have not been tested for it. The infant shots are 85% to 95% effective in preventing chronic hepatitis B infections, studies have shown.

Newborn hepatitis B vaccinations are considered a success, and no recent peer-reviewed research shows any safety problem with giving kids the shots on their first day of life, Schaffner said.

But Kennedy’s ACIP members suggested in June they wanted to revisit the guidance.

Schaffner noted that health officials used to rely on screening mothers before birth but that many cases were missed.

“There were lots of failures,” he said. “And so there were continuing transmissions from mother to child.”

MMRV

Chickenpox was once a common childhood annoyance, causing an itchy skin rash and fever.

But the highly contagious virus can also lead to complications such as skin infections, swelling of the brain and pneumonia. Severe cases are more common among teens and adults who get it for the first time. The virus — called varicella — also can reactivate later in life and cause the painful illness called shingles.

The government first recommended that all children get a chickenpox vaccine in 1995, leading to a dramatic drop in cases and deaths.

In 2006, a combination MMRV shot — measles, mumps, rubella and varicella — was licensed. The CDC initially recommended that doctors and parents use the combo shot over separate MMR and varicella injections.

But within a few years, studies showed children who got the combo shot more often developed a rash, fever and — in rare instances — seizures after vaccination compared with children who got separate shots.

In 2009, the ACIP changed its recommendation, removing the preferential language and saying either the combination shot or separate shots were acceptable for the first dose.

Today, most pediatricians suggest separate doses for the first shot, but give the combined shot for the second dose, pediatrics experts say.

Again, there’s no new evidence about harms from MMRV shots, said O’Leary, of AAP.

Why revisit it now?

“This version of the ACIP is an orchestrated effort to sow distrust in vaccines,” O’Leary said.

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

The governors of Arizona and Maine on Friday joined the growing list of Democratic officials who have signed orders intended to ensure most residents can receive COVID-19 vaccines at pharmacies without individual prescriptions.

Unlike past years, access to COVID-19 vaccines has become complicated in 2025, largely because federal guidance does not recommend them for nearly everyone this year as it had in the past.

Here’s a look at where things stand.

Pharmacy chain says the shots are available in most states without individual prescriptions

CVS Health, the biggest pharmacy chain in the U.S., says its stores are offering the shots without an individual prescription in 41 states as of midday Friday.

But the remaining states — Arizona, Florida, Georgia, Louisiana, Maine, North Carolina, Oregon, Utah and West Virginia, plus the District of Columbia — require individual prescriptions under the company’s interpretation of state policies.

Arizona and Maine are likely to come off that list as the new orders take effect there.

“I will not stand idly by while the Trump Administration makes it harder for Maine people to get a vaccine that protects their health and could very well save their life,” Maine Gov. Janet Mills said in the statement. “Through this standing order, we are stepping up to knock down the barriers the Trump Administration is putting in the way of the health and welfare of Maine people.”

Democratic governors have been taking action

At least 14 states — 12 with Democratic governors, plus Virginia, where Republican Glenn Youngkin is governor — have announced policies this month to ease access.

In some of the states that have expanded access — including Delaware and New Jersey this week — at least some pharmacies were already providing the shots broadly.

But in Arizona and Maine, Friday’s orders are expected to change the policy.

While most Republican-controlled states have not changed vaccine policy this month, the inoculations are still available there under existing policies.

In addition to the round of orders from governors, boards of pharmacy and other officials, four states — California, Hawaii, Oregon and Washington — have announced an alliance to make their own vaccine recommendations. Of those, only Oregon doesn’t currently allow the shots in pharmacies without individual prescriptions.

Vaccines have become politically contentious

In past years, the federal government has recommended the vaccines to all Americans above the age of 6 months.

This year, the U.S. Food and Drug Administration approved them for people age 65 and over but said they should be used only for children and younger adults who have a risk factor such as asthma or obesity.

That change came as U.S. Health Secretary Robert F. Kennedy fired the entire Advisory Committee on Immunization Practices in June, accusing of them of being too closely aligned with the companies that make the vaccines. The replacements include vaccine skeptics.

Arizona Gov. Katie Hobbs, a Democrat, framed her order Friday as “protecting the health care freedom” of people in the state.

One state has taken another stance on vaccines

Florida’s surgeon general, Dr. Joseph Ladapo, announced this month that the state could become the first to eliminate requirements that children have a list of vaccinations.

Since then, though, the state health department said that the change likely wouldn’t take effect until December and that without legislative action, only some vaccines — including for chickenpox — would become optional. The measles and polio shots would remain mandatory.

Associated Press writer Patrick Whittle in Maine contributed to this report.

Heading into the respiratory illness season, states and clinicians are working to encourage pregnant patients to get COVID-19 vaccinations, even though the U.S. Department of Health and Human Services no longer recommends that they should.

Along with being older and having an underlying health condition, pregnancy itself is a risk factor. Pregnant women are more vulnerable to developing severe illness from COVID-19. They’re also at high risk for complications, including preterm labor and stillbirth. The vast majority of medical experts say getting the shot is safe and effective — much safer than having the illness.

But HHS Secretary Robert F. Kennedy Jr. announced in May that the agency would no longer recommend that pregnant women get the vaccine. Before testifying before Congress in June, Kennedy circulated a document on Capitol Hill claiming higher rates of fetal loss after vaccination. But the authors of those studies told Politico that their work had been misinterpreted.

Experts say the federal shift puts the onus on state health agencies to ramp up vaccine guidance and outreach. Clinicians and public health organizations are trying to dispel misinformation and make sure information reaches low-income people and people of color, who had higher maternal death rates during the pandemic. During the first two years of the pandemic, the virus contributed to a quarter of maternal deaths, according to federal data.

“We are severely disappointed,” said Dr. Neil Silverman, a professor of clinical obstetrics and gynecology at the University of California, Los Angeles David Geffen School of Medicine. He has studied vaccines and pregnancy for the past 15 years and specializes in high-risk pregnancies.

Silverman called the federal shift a “public health tragedy on a grand scale.”

Vaccinations against COVID-19 help prevent severe illness in pregnant people as well as their newborns, who are too young to get vaccinated, Silverman said. In what’s called passive immunity, vaccinated mothers pass on antibodies to their babies through the placenta and through breast milk.

“State public health agencies are probably going to have to implement vaccine guidance that differs from the federal recommendations. And that’s going to be an interesting can of worms,” said OB-GYN Dr. Mark Turrentine, a professor of obstetrics and gynecology at the Baylor College of Medicine in Texas.

Turrentine serves on a board of the American College of Obstetricians and Gynecologists that focuses on immunization and infectious diseases. He said his recent pregnant patients who had COVID-19 hadn’t gotten the vaccine.

“The change in guidance on the federal level just really makes a lot of confusion, and it makes it very challenging to try to explain to individuals why all of a sudden the difference,” Turrentine said.

A slew of public health organizations have been making a concerted effort to dispel vaccine myths. They include the Society for Maternal-Fetal Medicine, a Washington, D.C.-based nonprofit organization of maternal-fetal experts. At a news briefing the society held this month, clinicians stressed the safety and long-standing science behind COVID-19 vaccines, as well as the shots for RSV and the flu. Cases of RSV and the flu tend to peak in the winter months, while in recent years COVID-19 cases have spiked in the summer and the winter.

Dr. Brenna Hughes, an OB-GYN who chairs the organization’s infectious diseases and emerging threats committee, pointed to survey data from the federal Centers for Disease Control and Prevention showing that less than a third of eligible pregnant patients received COVID-19 shots, and only 38% received RSV shots for the 2023 to 2024 season. Less than half — 47% — received flu shots, and 59% received TDAP (whooping cough) vaccines.

CDC data shows that for last year’s and this year’s season, only between 12% and 14% of pregnant patients got the COVID-19 vaccine.

“The complications from the infection are so much greater than the complications and the very few and typically minor adverse events that might occur from the vaccine,” said microbiologist Sabra Klein, a professor of molecular microbiology and immunology at the Johns Hopkins Bloomberg School of Public Health.

In June, the American College of Obstetricians and Gynecologists and 30 other professional health organizations signed a letter urging insurers to continue covering the COVID-19 shot for pregnant women, and have continued to urge coverage since then.

CVS Caremark, one of the nation’s three major pharmacy benefit managers, told Stateline it will continue covering the vaccine for pregnant women. The Arizona, California and North Carolina state Medicaid agencies also told Stateline they are still currently covering COVID-19 vaccines for pregnant women.

Dr. Kimberly Fortner, president-elect of the Infectious Diseases Society for Obstetrics and Gynecology, said during the maternal-fetal medicine briefing that she hopes medical groups’ joint messaging will bolster insurers.

“Hopefully by us linking arms, that can then help develop consistency so that insurers will continue to pay for the vaccine,” she said.

Exacerbating disparities

Dr. Ayanna Bennett, director of the District of Columbia Department of Health, said the federal government’s new stance has upended “a system that’s been stable for a very long time.”

Bennett said her agency used federal pandemic aid to shore up vaccine outreach efforts to communities of color. Now that flow of money is ending.

The changes in federal guidance and funding will “almost certainly exacerbate” maternal health disparities, said Marie Thoma, a perinatal epidemiologist and an associate professor in the University of Maryland Department of Family Science who researches pregnancy and COVID-19.

Black and Indigenous women died at higher rates. The virus exacerbated existing racial disparities in maternal health — and created new ones: Latina mothers, who generally see low rates of maternal mortality, saw deaths surge to 28 per 100,000 in 2021. Their rate was about 12 per 100,000 in 2018, according to federal data.

“We are going in with some exposure already that we didn’t have during the start of the pandemic. So, there will be some protection, but now that will erode,” said Thoma. “If we’re not getting vaccines, or if people are hesitant to take them, we could see some increase.”

Silverman said the administration’s efforts to strip mentions of race from government policies makes it difficult for institutions to reach populations at greatest risk. He called the dismissal of decades of data “saddening and infuriating.”

“The politicization of the vaccine process, or access to it, is what concerns me the most,” said Dr. Yvette Martas, a Connecticut OB-GYN who chairs the board of directors of the Hispanic Health Council.

Many women “are trying to navigate an economic system that’s not always in their favor in terms of also providing access to the kind of educational material that they need,” she said.

Not just COVID-19

In June, Kennedy ousted all 17 members of the CDC’s vaccine advisory committee, replacing them with some members who are vaccine skeptics.

The change is creating chaos. Some states have vaccine laws, such as mandates for kids and coverage statutes, that are specifically tied to the committee’s decisions.

The Vaccine Integrity Project at the University of Minnesota called on frontline health workers, health officials and professional societies to “counter the spread of inaccurate and confusing vaccine information.”

At a news briefing this month held by the Association of State and Territorial Health Officials, representatives from Alabama, Connecticut and Washington, D.C., said they will continue to recommend vaccines.

Alabama’s state health officer, Dr. Scott Harris, said clinicians will be instrumental in getting correct vaccination information to patients.

“We don’t think that we necessarily have the same authoritative voice that we might have had a decade ago in trying to guide people in what to do, but we do believe that people trust their health care providers in most cases and are certainly willing to listen to them,” he said at the briefing.

Bennett said she is hopeful that strong, consistent messaging from respected medical organizations will help combat confusion.

“Having established groups like the American Academy of Pediatrics or the American College of Obstetrics and Gynecology make very firm recommendations that keep us essentially not changed from where we have been, I think, should reassure families,” she said.

Stateline reporter Nada Hassanein can be reached at nhassanein@stateline.org.

©2025 States Newsroom. Visit at stateline.org. Distributed by Tribune Content Agency, LLC.

WASHINGTON (AP) — The government’s top vaccine official working under Health Secretary Robert F. Kennedy Jr. recently restricted the approval of two COVID-19 vaccines, disregarding recommendations from government scientists, according to federal documents released Wednesday.

The new memos from the Food and Drug Administration show how the agency’s vaccine chief, Dr. Vinay Prasad, personally intervened to place restrictions on COVID shots from vaccine makers Novavax and Moderna.

Both vaccines were approved by the FDA in May after months of analysis by rank-and-file FDA reviewers.

But internal correspondence show Prasad disagreed with staffers who planned to approve the shots for everyone 12 and older, similar to previous COVID vaccines. The scientists had concluded the benefit from the vaccines and the risk of COVID-19 outweighed the risk of possible side effects, which are rare.

Instead Prasad decided the shots should be limited to those who face special risks from the virus— seniors or children and adults with underlying medical issues.

Prasad explained that the COVID vaccine benefits must be reconsidered in light of falling rates of death and hospitalization and the possibility for vaccine side effects. It’s the latest in a series of vaccine restrictions imposed by officials working under Kennedy, who has long questioned the benefits of vaccines.

“Even rare vaccination related harms both known and unknown now have higher chance of outweighing potential benefits” Prasad wrote in a five-page memo explaining his decision.

COVID-19 remains a public health threat, resulting in 32,000 to 51,000 U.S. deaths and more than 250,000 hospitalizations since last fall, according to the Centers for Disease Control and Prevention. Most at risk for hospitalization are seniors and children under 2 — especially infants under 6 months.

Top FDA leaders are typically not involved in the review of individual products. Officials like Prasad can overrule staffers, but such cases are rare and often controversial.

News of the FDA documents was first reported by the New York Times.

Prasad was hired to lead the FDA’s vaccine center in May, after the previous director, Dr. Peter Marks, was forced to resign over disagreements with Kennedy. An academic researcher specializing in cancer therapies, Prasad came to prominence during the pandemic for criticizing public health measures, including the FDA’s approval of COVID boosters for healthy adults and children.

Since arriving at the agency he has worked with FDA Commissioner Mark Makary on new guidelines that will limit approvals of future COVID boosters to higher-risk Americans, mainly seniors and those with medical conditions like asthma and obesity.

Those limits match the terms FDA recently approved for Novavax’s shot, Nuvaxovid and Moderna’s mNexspike. Novavax’s vaccine is the only protein-based coronavirus vaccine available in the U.S. Moderna’s vaccine is an updated, lower-dose version of its existing mRNA-based vaccine.

The review team for the Novavax vaccine pointed to data from a study in 30,000 adults, concluding that “the risk-benefit assessment for this vaccine technology remains favorable.”

FDA staff reached a similar conclusion for the Moderna vaccine, deeming it similar in safety and effectiveness to the company’s original shot.

Last week, the FDA finalized new warning labeling about the risk of myocarditis, a rare form of heart inflammation, on shots from Moderna and Pfizer, the other maker of an mRNA-based shot for COVID.

In his “override memo,” reversing FDA staff’s decision on the Moderna shot, Prasad pointed to the ongoing risk of myocarditis and questions about its frequency. The agency ordered Moderna to conduct further studies of the risk as a condition for the approving its updated shot.

A spokesman for the administration said Prasad “has raised serious concerns” about the issue.

“We will not ignore these risks and will ensure that the gold standard of science is used for any decisions,” said Andrew Nixon, in an emailed statement.

Outside researchers have noted that cases of the heart condition tend to resolve quickly and are less severe than those associated with COVID infection itself, which can also cause myocarditis.

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

WASHINGTON (AP) — The Food and Drug Administration said Wednesday it has expanded existing warnings on the two leading COVID-19 vaccines about a rare heart side effect mainly seen in young men.

Myocarditis, a type of heart inflammation that is usually mild, emerged as a complication after the first shots became widely available in 2021. Prescribing information from both Pfizer and Moderna already advises doctors about the issue.

In April, the FDA sent letters to both drugmakers asking them to update and expand the warnings to add more detail about the problem and to cover a larger group of patients. While the FDA can mandate label changes, the process is often more of a negotiation with companies.

Specifically, the new warning lists the risk of myocarditis as 8 cases per 1 million people who got the 2023-2024 COVID shots between the ages of 6 months and 64 years old. The label also notes that the problem has been most common among males ages 12 to 24. The previous label said the problem mostly occurs in 12- to 17-year-olds.

The FDA’s labeling change appears to conflict with some prior findings of scientists elsewhere in the U.S. government.

The Centers for Disease Control and Prevention previously concluded there was no increased risk of myocarditis detected in government vaccine injury databases for COVID-19 shots dating back to 2022. Officials also noted that cases tend to resolve quickly and are less severe that those associated with COVID-19 infection itself, which can also cause myocarditis.

The FDA announcement came as new vaccine advisers appointed by Health Secretary Robert F. Kennedy Jr. met to debate the continuing use of COVID-19 vaccines for key groups, including pregnant women and children. It’s the first meeting of the CDC advisory panel since Kennedy abruptly dismissed all 17 members of the group, naming a new panel that includes several members with a history of anti-vaccine statements.

The FDA’s label update is the latest step by officials working under Kennedy to restrict or undercut use of vaccines. FDA Commissioner Marty Makary and a top deputy recently restricted annual COVID-19 shots to seniors and other Americans at higher risk from the virus. They’ve also suggested seasonal tweaks to match the latest circulating virus strains are new products that require extra testing.

Outside experts said the new warning is the wrong approach.

“They are right to suggest that we need to consider myocarditis risks associated with the vaccine, but what they propose is exactly the wrong solution,” said Dr. Robert Morris of the University of Washington. “We should be investigating who is prone to myocarditis to see if we can predict and mitigate that risk.”

Makary and several other recent FDA appointees gained prominence during the pandemic by suggesting the federal government exaggerated the benefits of COVID-19 boosters and downplayed serious side effects, including myocarditis.

Before joining the government, Makary and two of his current FDA deputies wrote a 2022 paper that said mandating booster shots in young people would cause more vaccine-related injuries than prevented hospitalizations from COVID-19 infections. The conclusion was contradicted by many leading vaccine and public health experts at the time, including at the CDC.

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.

The COVID-19 variant that may be driving a recent rise in cases in some parts of the world has earned a new nickname: “razor blade throat” COVID.

That’s because the variant — NB.1.8.1. or “Nimbus” — may cause painful sore throats. The symptom has been identified by doctors in the United Kingdom, India and elsewhere, according to media outlets in those countries.

Other COVID-19 symptoms of any variant include fever, chills, cough, shortness of breath or loss of taste or smell.

Experts say there isn’t major cause for concern with the Nimbus variant, but here ‘s what else you need to know about it.

Here’s where the variant causing ‘razor blade throat’ is spreading

The rise in cases late last month is primarily in eastern Mediterranean, Southeast Asia and western Pacific regions, the World Health Organization said May 28. The new variant had reached nearly 11% of sequenced samples reported globally in mid-May.

Airport screening in the United States detected the new variant in travelers arriving from those regions to destinations in California, Washington state, Virginia and New York.

You aren’t likely to get sicker from this variant than others

Not so far, anyway.

The WHO said some western Pacific countries have reported increases in COVID cases and hospitalizations, but there’s nothing so far to suggest that the disease associated with the new variant is more severe compared to other variants.

COVID-19 vaccines are effective against the Nimbus variant

Yes.

The WHO has designated Nimbus as a “variant under monitoring” and considers the public health risk low at the global level. Current vaccines are expected to remain effective.

Health Secretary Robert F. Kennedy Jr. announced last month that COVID-19 shots are no longer recommended for healthy children and pregnant women — a move immediately questioned by public health experts.

AP Health Writer Carla Johnson contributed to this story.

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.

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., who was a longtime anti-vaccine activist, said this week that the shots are no longer recommended for healthy children and pregnant women, usurping a decision normally made by scientific experts, not political appointees.

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

Until now, the U.S. – following guidance from independent experts who advise the Centers for Disease Control and Prevention – has recommended yearly COVID-19 vaccinations for everyone age 6 months and older.

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 of this season’s vaccine is still available. Insurance industry experts say if people had insurance coverage before Kennedy’s announcement, it’s highly unlikely that would have ended instantly based on the secretary’s video announcement. That means if someone could find a shot, they’d likely be able to get one 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.

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.

COVID-19 cases are rising again as a new variant begins to circulate in some parts of the world. The World Health Organization said Wednesday the rise in cases is primarily in the eastern Mediterranean, Southeast Asia and western Pacific regions.

Airport screening in the United States has detected the new variant in travelers arriving from those regions to destinations in California, Washington state, Virginia and New York.

The new variant is called NB.1.8.1. It arrives as the United States’ official stance on COVID-19 vaccination is changing. On Tuesday, Health Secretary Robert F. Kennedy Jr. announced that COVID-19 shots are no longer recommended for healthy children and pregnant women — a move immediately questioned by several public health experts.

The new variant, increasing globally, had by mid-May reached nearly 11% of sequenced samples reported. The WHO has designated it a “variant under monitoring” and considers the public health risk low at the global level with current vaccines expected to remain effective.

The WHO said some western Pacific countries have reported increases in COVID cases and hospitalizations, but there’s nothing so far to suggest that the disease associated with the new variant is more severe compared to other variants.

The variant called LP.8.1 is currently the dominant version in the U.S. and globally.

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.