Confused over the conflicting COVID vaccine guidance? Here's what to know

San Francisco Chronicle​

21 hours ago

Federal health officials have in recent weeks given conflicting — and at times confusing — guidance around who should get vaccinated against COVID-19. These changes mark a significant departure from the Centers for Disease Control and Prevention's previous recommendations, which advised everyone 6 months and older to get the vaccine.
On May 20, Dr. Marty Makary, commissioner of the Food and Drug Administration, published an article in the New England Journal of Medicine saying the FDA will make the vaccine available only to adults 65 and older and people with at least one underlying medical condition — meaning vaccines will no longer be recommended for healthy adults under 65.
On May 27, Health Secretary and longtime vaccine skeptic Robert F. Kennedy Jr. unilaterally announced that the federal government no longer recommends the vaccine for children and pregnant women, and that the vaccine was removed from the immunization schedule recommended by the Centers for Disease Control and Prevention.
But days later, the CDC partly contradicted this pronouncement, saying the vaccine will remain on the childhood immunization schedule — but added a new clarification that parents should consult with their children's doctor when deciding whether to get their child immunized. The CDC offered no formal guidance on whether pregnant women should get the vaccine, though its website lists pregnancy as an underlying condition that puts someone at higher risk of severe COVID and thus makes them eligible for vaccination going forward.
What should you do?
One practical thing to keep in mind, according to some experts, is you may just want to wait and see how things shake out. The next updated COVID vaccine, for 2025-26, won't be rolled out until the fall. And before then, we may get more clarity on who it will be recommended for — and thus whom health insurers will cover it for. Insurers typically pay for vaccines only if they're recommended by the federal government.
We may get clarification this month: The Advisory Committee on Immunization Practices, an outside panel of scientific experts that advises the CDC on vaccine recommendations, is scheduled to meet June 25-27 to vote on 2025-26 COVID vaccine recommendations.
Historically, this panel has advised the CDC director on vaccine recommendations, and the CDC then communicates its recommendations with the public. Kennedy bypassed this long-held protocol by going ahead and changing vaccine recommendations without input from the CDC's advisory panel.
As it stands:
Adults 65 and over
The recommendation for this group is not changing. Adults 65 and older should get the COVID vaccine every six months. This group can expect to get the same access to vaccination as they've had since the pandemic began, meaning their insurer should continue covering it since the federal government recommends it for them.
People 6 months and older with at least one underlying medical condition
The vaccinations are also still recommended for those in this age group with one or more underlying conditions putting them at higher risk for severe COVID.
Pregnant women
The federal government's position on whether pregnant women should get immunized is unclear. While Kennedy said the vaccine for pregnant women was no longer recommended by the CDC, the FDA's Makary said a day later that the decision to vaccinate should be made by the pregnant person and their doctor.
Infectious disease experts and obstetricians urge pregnant women to get the vaccine. This is because pregnant people who get COVID are more likely to develop severe disease, need hospitalization and ICU care, and experience pregnancy complications including preeclampsia, miscarriage, preterm birth and higher likelihood of developing blood clots, said Nadia Roan, a UCSF professor and senior investigator at Gladstone Institutes who studies immunology.
'There's a ton of data that's been generated over recent years suggesting that boosting or vaccination during pregnancy is beneficial,' said Roan, who is researching COVID boosters in pregnant people.
Also, getting immunized during pregnancy is the only way to pass protection on to the fetus, and have the infant protected in early life.
'If you vaccinate and you're in the third trimester, you're essentially vaccinating your fetus,' said Dr. George Rutherford, a professor emeritus of epidemiology and biostatistics at UCSF. 'That's a good thing because it's not approved for people under 6 months yet. So this is how we get to that population.'
If you're pregnant and wondering whether you should get the current 2024-25 vaccine now — in case you can't get the updated 2025-26 vaccine later due to new federal recommendations that have yet to be determined — 'I'd say yes because I'm not sure it'll be covered in the fall,' said Dr. Peter Chin-Hong, an infectious-disease specialist at UCSF.
'It's not harmful, particularly if you haven't had one in the last year,' he said.
The vaccine is safe to get at all stages of pregnancy, he said.
Healthy adults under 65
For this group, whether to get vaccinated is a little more open to interpretation, experts said, and can factor in things like each person's risk tolerance, job and living situation.
'I'd talk to their health care provider at the end of the day to help guide them more,' Chin-Hong said. 'Everyone has different situations and circumstances.'
You may want to lean toward vaccination if, for instance, you plan to travel this summer (when abroad, you don't have access to your usual health care providers) or if you live with immunocompromised or older adults and want to lower the chances of spreading COVID to them.
'In general, (healthy adults) are going to do fine, so to me it's really about protecting the people who are most vulnerable,' Chin-Hong said.
Children
About 2,000 children in the U.S. have died from COVID since 2020, and more than 200,000 have been hospitalized. Those numbers are much lower compared with people in higher-risk groups, especially those over 65, and most healthy children likely experience mild or moderate symptoms.
Still, many infectious diseases experts say the benefits of vaccination do still outweigh the risks — though that calculus is much closer than it is for pregnant people and adults over 65.
'It's a small number compared to deaths in many other age ranges, but that's deaths, many of which could've been prevented if they were vaccinated,' said Dr. John Swartzberg, a clinical professor emeritus of infectious diseases at UC Berkeley School of Public Health.
The vaccines have proved safe and effective in children, lower the likelihood of severe disease, and help reduce long COVID risk, Roan said.
'The risks (of vaccination) are very low, and these vaccines have been shown to be safe,' Roan said. 'So I think the benefits definitely outweigh the risks. But it's up to each individual to make that decision.'