Updated September 9, 2025 at 1:03 PM EDT
One thing certain about the COVID vaccine right now is that everything about it is changing.
New rules are causing confusion over who can and who can't get the updated COVID-19 shot.
Health Secretary Robert F Kennedy Jr. and other top Trump administration health officials claim that at this point in the pandemic, existing immunity removes the need for continued boosters.
So the new updated COVID vaccine shots have only been approved for people who are at increased risk of complications from the virus.
For now, that at-risk group has been defined as people who are 65 or older, or any young people who have other health issues that make COVID especially risky.
An advisory group for the Centers for Disease Control and Prevention is expected to meet later this month and will issue formal recommendations for how they can be prescribed and who can get them – and this will affect whether insurance covers them too. Until then, rules and guidance vary state by state.
Doctors groups like the American Academy of Family Physicians have issued guidance recommending that all adults over 18 get the updated COVID shots this fall. The American Academy of Pediatrics says all young children ages 6-23 months should get vaccinated. Children between the ages of 2 and 18 with certain risk factors should also get the shot.
With states launching their own health care alliances to provide guidance about vaccines to doctors, pharmacists and patients, people are seeking vaccinations for themselves and their loved ones are sure to have plenty of questions. So we asked NPR listeners to let us know what they'd like to know about these upcoming changes.
Dr. Peter Chin-Hong, an infectious disease expert with the University of California, San Francisco, joined Consider This to give you some answers.
How big of a risk is COVID-19 right now?
CDC data shows that the number of people testing positive for the virus and showing up in emergency rooms to be treated for COVID rose steadily through July and early August, to the highest levels of the year. But positive test rates have now started to drop.
According to Chin-Hong, your personal risk depends on factors like your age.
"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 hospital. They tend to be older, particularly older than 75, and they might have gotten a lot of vaccines early in the pandemic, but didn't get one in the last year or so."
Why are just those 65 and older being recommended to get vaccinated twice a year?
That's the group that is driving deaths and hospitalizations from COVID infections, says Chin-Hong.
"It's kind of like influenza 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," he said.
"And that's why we need to continue to remind the immune system [how to fight it off] 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."
What now counts as a pre-existing condition?
An estimated 30 to 60% of Americans have a pre-existing condition based on the FDA's previous parameters, says Chin-Hong.
Those conditions include things like obesity, asthma and even depression and diabetes.
The problem he explained is that, "we are not really sure if that will be ratified by the new advisory board to the CDC in their upcoming meeting. And secondly, even if you have a comorbidity and you're younger, how is it going to be enforced with the pharmacist?"
Will a prescription be sufficient? Or will additional documentation be required?
"You can get a prescription from your clinician to get a vaccine, [and that's what] we call off-label. But there's several issues with that," Chin-Hong said.
"First of all, you need to have somebody write you the prescription. Secondly, the pharmacist has to accept that."
"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."
Are those with children able to get them vaccinated with the new version of the COVID-19 vaccine this fall?
At this time, Chin-Hong believes that kids 18 under will be able to receive vaccines in the updated formulation.
"You need to have a conversation with your health care provider first, and that's called informed decision making or shared decision making."
Then, the challenges of access to health care become a part of the equation.
"It will be seen 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, Chin-Hong brings up, is payment for the vaccine.
"We know that the FDA will likely have already approved those who have co-morbidities, 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."
Are caregivers under 65 eligible for COVID and flu vaccines? What about nurses and health aides?
"Right now, if you're a health care worker, you're under 65, and you have no comorbidities, you will not be able to get the vaccine unless you have a prescription and it's prescribed off-label," says Chin-Hong.
The American Academy of Pediatricians do recognize that people who live in households with immunocompromised, vulnerable populations should be a group that get the vaccine, he explained.
"But again, that's not what is available under the current FDA guidance."
How can I find a COVID vaccine in my area?
As different health care alliances are set up in different regions, vaccine guidance will vary.
"Right now, it's going to be the same system we've used depending on your area, looking at Walgreens and CVS, talking to your health care systems," says Chin-Hong. "It's very confusing right now. And we're looking for guidance as in the next few weeks."
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This episode was produced by Brianna Scott. It was edited by Courtney Dorning and Carmel Wroth.
Our executive producer is Sami Yenigun.
Copyright 2025 NPR
