As autumn approaches, vaccine eligibility in the U.S. has shifted, raising important questions — particularly for adults over 55. New guidance from the Food and Drug Administration (FDA) now allows access to updated COVID-19 vaccines only for those aged 65 and older, or younger individuals with medical conditions that heighten their risk of severe illness. This marks a significant departure from previous years, when nearly everyone aged 6 months and up could get vaccinated.
Meanwhile, decisions from the Centers for Disease Control and Prevention’s (CDC) Advisory Committee on Immunization Practices panel (ACIP) remain highly confusing, thanks to controversial political maneuvering, leaving many people wondering what to expect in the weeks to come.
All these mixed messages mean the 55-plus crowd falls into a gray area—safe and recommended by medical professionals, yes, but potentially barred from easy access without underlying risk factors or a clinician willing to provide an “off-label” prescription. Although guidelines and rules seem to shift as quickly as the wind these days, we’ll do our best to walk you through what’s changed, why it matters, and what options are still on the table for those over 55.
The Recent Hearings Regarding Vaccinations
On September 19, the ACIP issued the recommendation that COVID-19 vaccinations be subject to a process called “shared decision making.” This phrase, according to National Public Radio (NPR) and the New York Times, means that the COVID-19 vaccine can be obtained by anyone over the age of 6 months, but only after consulting with a clinician about the risks and benefits. They further stipulated that for anyone under the age of 65, the clinician should emphasize that “benefits are greatest for people with the most risk of serious disease, and lowest for people without increased risk.”
In addition, the ACIP advisors voted that the CDC should add information about the possible risks and uncertainties related to COVID vaccine effectiveness to information sheets that are routinely given out during clinician consultations. However, NPR reports that many of the “risks” they want to add to the sheet are speculative, and some are already known to be unfounded.
What makes everything even more confusing is that it remains unclear whether the ACIP’s recommendations contradict the Food and Drug Administration’s (FDA) authorization of the shots for only those over 65 and younger people with certain health conditions.
Which Shots Are Approved/Recommended, and For Whom?
The contradicting orders from the government are already leading to widespread hesitation and not just for prospective patients. NPR reports that regardless of their insurance coverage, many patients across the country trying to get vaccinated are getting turned away from pharmacies, who cite uncertainty about current policy. (Anecdotally, at my annual check-up last week I watched as the nurse automatically “deferred” my vaccination options, and explained they were doing that for any patients under the age of 65 until more clarity is available.)
It is important to keep in mind that as of the writing of this article, most of the vaccination controversies are limited to the debate over recommendations for children, and the limitations for the COVID-19 vaccine. Many of the usual official recommendations for seasonal vaccinations have not changed, so please seek them out accordingly.
Many experts expressed grave concerns during the recent deliberations that the changing policies would lead to people avoiding their seasonal vaccinations, reducing our herd immunity and allowing certain diseases to once again gain a foothold in our country. The limitations to access and availability as a result of these new policies remain to be seen, but if you can get the shots, many medical experts advise that you do.
For Flu:
As in years passed, the CDC strongly advises that everyone over the age of 6 months get a seasonal flu vaccine every year. Although the ACIP recently voted to restrict the use of influenza vaccines that use thimerosal as a preservative, it is not likely to impact your ability to get vaccinated, as those only constitute about 5% of U.S. flu vaccines.
On a positive note, last September the FDA approved FluMist (the nasal spray flu vaccine) for self- or caregiver-administration for recipients aged 2 – 49 years of age. (In clinical trials, researchers found that FluMist was less effective in people 50 and older, so it is still recommended that adults 65 and older should get a high-dose version of the vaccine via injection.) Experts believe this will still benefit the older demographic, because increasing availability and ease of access will improve herd immunity, decreasing community spread of the illness.
Other CDC Recommendations:
- Pneumococcal Vaccines: The CDC recommends pneumococcal vaccination for all adults over the age of 50 who have never received a pneumococcal conjugate vaccine;
- Shingles: Adults 50 and over should get two doses of the shingles vaccine separated by 2 to 6 months, in order to have protection against the painful disease.
- RSV: Adults aged 60-74 at increased risk of severe RSV and all adults 75+ should get a single dose of RSV vaccine. (The RSV vaccine is not currently recommended as an annual shot; additional data is needed to determine how long one dose can offer protection from RSV, but two of the three FDA licensed options are thought to provide two years of protection.)
- Whooping Cough: The CDC still recommends getting your TDAP (tetanus, diphtheria, and pertussis) booster every 10 years.
For COVID-19:
The FDA has approved:
- Moderna’s mRNA vaccine for those ages 6 months and older
- Pfizer-BioNTech mRNA vaccine for those 5 and older
- Novavax vaccine for those ages 12 and older
The CDC voted to recommend vaccination against COVID-19 for adults 65 and older, and for younger people who have discussed the vaccine’s risks and benefits with a clinician — which could be defined as a physician, nurse, and/or pharmacist, according to their references.
As of the writing of this article, coverage for COVID-19 immunizations will still be allowed through entitlement programs including Medicaid and Medicare, according to the September 19 press release issued by the Department of Health and Human Services. Also, it is likely that COVID-19 vaccines will be covered with no cost-sharing through most private insurances, according to a statement issued by America’s Health Insurance Plans, the industry group for private insurance companies.
For those living in New York, Gov. Kathy Hochul has also announced the release of the state’s own COVID-19 vaccine guidance recommending the vaccine for everyone aged 6 months and older (including high risk individuals), in the hopes that residents will continue to have access to vaccines regardless of national guidelines. (The state’s guidance aligns with consensus COVID-19 recommendations agreed upon by the Northeast Public Health Cooperative, a group of states from Maine to Maryland that have banded together to support evidence-based health provisions.) She has also signed an executive order allowing pharmacists to prescribe and administer COVID-19 vaccines.
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