JUANA SUMMERS, HOST:
One thing certain about the COVID vaccine right now is that everything about it is changing.
(SOUNDBITE OF MONTAGE)
UNIDENTIFIED REPORTER #1: New rules are now causing some confusion over who can and cannot get the updated COVID-19 shot.
UNIDENTIFIED REPORTER #2: Growing confusion over the COVID vaccine. CVS, the nation's largest pharmacy chain, is now limiting access to the vaccine in some states, even as COVID cases rise.
UNIDENTIFIED REPORTER #3: CVS told us that you do have to have a prescription from your doctor to get the vaccine in New York.
SUMMERS: The Food and Drug Administration recently approved the next round of COVID-19 vaccines for the fall season, but it significantly changed just who can get it. That move comes amid a broader effort by the Health and Human Services secretary, Robert F. Kennedy Jr., to change policy and guidance around many vaccines. Meanwhile, earlier today, California, Oregon and Washington state launched the new West Coast Health Alliance. The goal, the governors of those states say, is to provide clear and transparent communication about all vaccines.
And at this point, we're guessing you have lots of questions about vaccination in general, but especially around COVID vaccines. That's why we asked our NPR listeners to submit their questions about the FDA's new COVID vaccine guidance. And here to help us answer some of those questions is Dr. Peter Chin-Hong. He's an infectious disease expert with the University of California San Francisco. Welcome to the program.
PETER CHIN-HONG: Thanks for having me on, Juana.
SUMMERS: Thanks for being here. I wonder if we can just start by reminding people what this new FDA guidance for the COVID vaccine this season actually says.
CHIN-HONG: So what the guidance says is that we will continue to vaccinate those who are 65 and older with or without comorbidities, those who are under 65 with comorbidities. And for those who are under 18 and over 6 months, you can also get it, but you need to talk to a health care provider first.
SUMMERS: And how different is that from guidance that we've received about COVID vaccination in the past?
CHIN-HONG: In the past, it was just very simple. It was simply those who are 6 months and older, regardless of health status, regardless of health access, to talking to a provider. It was pretty straightforward. You can go up to Walgreens or CVS, roll up your arms, and you can have it.
SUMMERS: I think one thing that a lot of people, including myself, I have to say, are wondering is just how big of a risk is COVID right now?
CHIN-HONG: Well, COVID is existing in two worlds. And I think that's why it's hard. For most people, it's not a big issue, not like 2020. But for some people, it's like it's 2020 all over again. Those are the people I'm still seeing in the hospitals. They tend to be older, particularly older than 75. And they might've gotten a lot of vaccines early in the pandemic but didn't get one in the last year or so.
SUMMERS: All right, I want to bring in our first listener question. And this is a topic that we got multiple questions about. Let's hear from Karen Moore (ph). She's 68, and she lives in Wisconsin.
KAREN MOORE: I know that all of us over age 65 need to be vaccinated twice a year. How does the FDA deem that an under 65 adult is high enough risk to be worthy of getting the vaccine?
SUMMERS: So just simply put, why ages 65 and older?
CHIN-HONG: Well, that's the people who are still driving deaths and hospitalizations. It's kind of like influenza in a way or other serious respiratory illnesses. Even though the rest of the population have very high immunity, those who are older than 65 have an immunity that drops very quickly. And that's why we need to continue to remind the immune system at least once a year. If you can do it twice a year, that's even better. But once a year is the minimum time, I think, a person older than 65 should have their immune system remember what COVID looks like.
SUMMERS: All right. I want to bring in another listener question. Now, Doctor, this is Sarah Corsi (ph). She's 36 years old and lives in Maryland.
SARAH CORSI: What counts as a preexisting condition given this new guidance for anyone under 65? My son had reflux as a baby, and I have been diagnosed as prediabetic. Are these preexisting conditions? Do I qualify for my booster?
SUMMERS: So just to scope this out here, what health problems constitute the ability to get a COVID vaccine if you're outside of those age groups that are listed?
CHIN-HONG: Yeah, so it's estimated that up to 30% to 60% of Americans - when you look at the old criterion, anyway - would have a preexisting condition. They include things like obesity or asthma or even depression, diabetes, certainly. The problem is we're not really sure if that will be ratified by the new advisory board to the CDC in the upcoming meeting. And secondly, even if you have a comorbidity and you're younger, how is it going to be enforced? Would the pharmacist just allow you to attest it and check off a box, or would you be needing a prescription? So those are the questions that I have. But again, you know, we will get more information in the upcoming weeks.
SUMMERS: This is a question that we actually got from James Holsey (ph). He's 61 and from Missouri, on that same theme.
JAMES HOLSEY: Will a doctor's prescription be sufficient or will additional documentation be required?
SUMMERS: I mean, we know that for people who are outside of the FDA's recommendations, they may be able to get a shot prescribed by their doctor. But is that enough?
CHIN-HONG: Yeah, so you can get a prescription from your clinician to get a vaccine, what we call off-label. But there are several issues with that. First of all, you need to have somebody write you the prescription. Secondly, the pharmacist has to accept that. They probably will. But again, we need more guidance. But, yes, the idea is that clinicians can give several things off-label, historically speaking. But it depends on the clinician, depends on the pharmacist. So there are a lot of what-ifs in that statement. There would be some variability. And that's why a simpler rule is oftentimes better in the vaccine world. But nevertheless, some people will be able to get it that way.
SUMMERS: I want to move to a different population. And this is a question that's come up a lot in my own social circles. Let's hear from 41-year-old Bridget Valdez Kogle (ph). She lives in Washington State.
BRIDGET VALDEZ KOGLE: Are we able to get our children vaccinated with the new version of the COVID-19 vaccine this fall?
SUMMERS: Now, Valdez Kogle has two kids. And we heard from a lot of parents who are really concerned about whether or not they're going to be able to get their young kids vaccinated. What would you say to parents like Bridget?
CHIN-HONG: At this time, we believe that kids 18 and under will be able to have vaccines in the updated formulation. However, you need to have a conversation with your health care provider first. And that's called informed decision-making or shared decision-making. So if people don't have access to a health care provider, it may be a little bit more difficult. It'll be seeing how the pharmacist will interpret that conversation to be able to give that vaccination. You may have many people getting vaccinations again in the pediatrician's office like before.
The other issue around that is payment. We know that the FDA will likely - has already approved those who have comorbidities who are younger. But for healthy kids, even after a conversation, it may not be covered very easily by insurance. It needs to be seen whether or not various insurance companies will accept this.
SUMMERS: I want to bring in one more question. And this one comes from Jeffrey Seaman (ph) in Indiana. He is 62.
JEFFREY SEAMAN: I care for my wife, who has several diagnoses that make her vulnerable for COVID complications. Are caregivers under 65 eligible for COVID and flu vaccines? Also, are nurses and health aids eligible for vaccines?
SUMMERS: Doctor, how do people who care for or work with vulnerable, immunosuppressed populations fit into this current FDA COVID vaccine guidance?
CHIN-HONG: That's a great question. Right now, if you're a health care worker, you're under 65, you have no comorbidities, you will not be able to get the vaccine unless you have a prescription and it's prescribed off-label. This is different from some other countries. The American Academy of Pediatricians do recognize that people who live in households with immune compromised or vulnerable populations should be a group that, you know, should get the vaccine. But again, that's not what is available under the current FDA guidance.
SUMMERS: And then I do have to ask you a basic question that we got from a lot of people. How can a person actually go about finding a COVID vaccine in their area?
CHIN-HONG: Again, that guidance is going to be changing as different alliances get set up, the West Coast, the East Coast, conglomerations, health systems, etc. But, you know, right now it's going to be the same system we've used, depending on your area. You know, looking at Walgreens or CVS, talking to your health care systems. And again, it's very confusing right now. And, you know, we're looking for guidance in the next few weeks.
SUMMERS: We've been able to offer a lot of advice to specific listeners' questions. We've talked about a lot of specific guidance. But before I let you go, Doctor, I just wonder, do you have any words of wisdom for people out there right now who might feel confused or lost given a lack of clear guidance?
CHIN-HONG: Again, what I try to tell my patients is that although it seems that a lot of things are changing, and they are, some things are not changing. And that's really those who are 65 and older. It's very simple. You can still get your vaccine. It will be covered. Please get the vaccine. I'm seeing people like you in the hospital and it's completely preventable.
And the next pearl is, don't forget about early antivirals. Even if you couldn't get a vaccine and you're very sick, we still have Paxlovid, remdesivir. We can give those easily. You need to get an early diagnosis. And the third pearl is, don't forget the ABCs of just any respiratory virus prevention - wearing that mask if it seems risky, thinking about ventilation, washing your hands and staying home if you're sick.
SUMMERS: Dr. Peter Chin-Hong is an infectious disease expert with the University of California San Francisco. Thank you so much for coming out and answering some of our questions.
CHIN-HONG: Thanks so much, Juana.
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