Title: The Latest on COVID Shots

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Brian: It's The Brian Lehrer Show on WNYC. Good morning again, everyone. For those of you wanting the latest COVID vaccine this fall, things have suddenly gotten more complicated. The FDA, as you probably heard, approved the updated Pfizer and Moderna vaccines, but that doesn't mean you can walk into a pharmacy and get the shot like you may have in the past. To talk about where things stand now and the next steps in this process, and to answer your questions to the extent that we can at this point, we're joined by Caroline Lewis, healthcare reporter for WNYC and Gothamist, who has a new story on COVID vaccines, plus has looked at the back-to-school picture for childhood vaccines. Caroline, always great to have you on the show. Hi.

Caroline: Hi, Brian.

Brian: There's a lot to unpack. Let's just start, for people who've missed it, with that FDA approval for the new versions of the vaccine tailored to the latest variant of the virus, but with limitations. What's new here?

Caroline: Like you said, we have approvals for vaccines from multiple manufacturers. This year, they have been broadly approved for people over 65, and then only for younger people, if they have certain health conditions that put them at higher risk for severe symptoms if they get COVID. The FDA was not really specific about those conditions, but the CDC does have this sort of long-term conditions that put people at higher risk up online. It's a pretty wide range of conditions. I think people are still concerned and partly confused about what real access will look like this year.

Brian: Let's go down the generational ladder a little bit. First, for people over 65 who are automatically qualified, I gather, I've heard some speculation in the news media that even for people over 65, it might be more complicated to get a COVID vaccine now. Does your reporting indicate that at all?

Caroline: I think that one issue right now, in particular, in New York, has to do with pharmacies, where basically in New York, pharmacies need a standing order to give vaccines, and that's a blanket prescription for anyone who qualifies. Those standing orders are typically based on recommendations from the Federal Advisory Committee on Immunization Practices.

That committee has yet to issue its official sort of recommendations on the COVID vaccines, and so there are no standing orders, and a lot of pharmacies are paralyzed at the moment and not offering the shots at all. Whereas, national chains, like CVS and Walgreens, say, "We're offering the shots in New York, but you need a prescription from your doctor, which is something that has never been required in the past.

Brian: Again, you're talking about even for people over 65?

Caroline: Yes. I've gone on the scheduling sites for CVS and Walgreens, it asks your date of birth, and then it also asks if you have a qualifying condition. Even if you are approved in some way, they're saying they're still going to require a prescription from your doctor in New York and certain other states that rely on these recommendations from the advisory committee that I was talking about. That advisory committee is supposed to meet and talk about COVID vaccines later this month. Once they come out with their recommendations, maybe that'll change. Already, we're seeing that the way that federal guidance is being rolled out is different this year and is creating these new hurdles and confusion.

Brian: Here's another example, folks, of how scrambled this all is. This is from NJ Spotlight News. Just yesterday, it says, "Major pharmacy chains like CVS and Walgreens are pulling back access to COVID-19 vaccines following new guidelines from the federal government. CVS will completely stop offering the shots in three states." Massachusetts, I know we have listeners in Massachusetts. Hello, Massachusetts. "CVS will completely stop offering the shots in Massachusetts, Nevada, and New Mexico." We get calls from New Mexico sometimes, too, so hello out there.

It says, "Amy Thibault, a spokeswoman for CVS, said the pharmacy chain will require a prescription in 13 other states and Washington, DC. They say the decision was based on the current regulatory environment. The updated vaccine will still be available to anyone in New Jersey at all CVS locations." That makes it sound blanket for the many of you in New Jersey that it's still going to be like it was. "The updated vaccine will still be available to anyone in New Jersey at all CVS locations, including for people without a prescription," from NJ Spotlight News. What a range. You can't get it from CVS at all in Massachusetts, if this is accurate, but anyone can get it in New Jersey, Caroline?

Caroline: Actually, it's interesting. In New Jersey, they're not doing this prescription thing. I did also go on their websites, the websites of Walgreens and CVS, and try to sign up for a vaccine in New Jersey, and they do still ask if you have one of these qualifying conditions. You could say that you do, and I don't know how closely they check, but if you say that you don't, they're like, "Too bad." [chuckles]

Brian: Listeners, who has a question? 212-433-WNYC. We will answer it to the best of our ability at this point, 212-433-9692, or help us report the story. Have you already tried to get a COVID vaccine for this fall? I know it's early since this new limitation was announced. What was your experience like? Do we have any doctors listening right now? Doctors, please call in. Pharmacists, listening, please call in who want to share what your plans are now for giving prescriptions or shots. Call or text 212-433-WNYC, 212-433-9692.

Caroline, HHS Secretary, RFK Jr, posted to social media that "vaccines are available for all patients who choose them after consulting with their doctors." That was meant to be reassuring, but I don't know if it's also misleading. Does that mean with a prescription?

Caroline: I think it is somewhat misleading just in the sense that doctors are still trying to sift through all this conflicting guidance. I think because of the confusion, each doctor is going to have a different policy. That's what I'm hearing so far from parents, for instance, who are reaching out to pediatricians. Even within the same provider, I talked to a few parents who go to Tribeca Pediatrics, which has locations around the city.

They showed me screenshots of their correspondence, and in one case, it said, "We're waiting for the recommendations from this advisory committee." In another, it said only certain immunocompromised patients are going to be eligible for the shots. It seems like everyone is still working this out. I've talked to some doctors who say, "Listen, we're going to follow guidance from other professional groups like the American Academy of Pediatrics, which has its own guidance."

Then their question is, if we veer away from what the FDA guidelines are on these shots, will they still be covered by insurance? If we veer away from the Advisory Committee on Immunization Practices, will it still be covered by insurance? If it's not necessarily going to be covered by insurance, will doctors still order the shots and have a large supply of them if they're not sure they're going to get reimbursed? I don't know. [chuckles] It's this trickle-down effect, I think, that is causing questions about what access will look like.

Brian: Does that mean that there, from the insurance company's perspectives, might be specific diagnoses that will be required from a doctor who prescribes a COVID shot for somebody under 65, that they'll only cover it, the insurance companies will, if it's for this condition or that condition, but not for some other conditions, that the doctors may think, "Sure, let's protect you against potential side effects, potential exacerbating effects of COVID by giving you a shot?"

Caroline: I think we do have to see what this advisory committee is going to recommend because that often informs what the insurance requirements are, but I think that there will be a lot of discretion. So far, I spoke to a spokesperson for the New York Health Plan Association, which represents insurers, and they said that for some plans, they're saying that their coverage will be the same as it has been. Others are evaluating the current situation. I think there's just a question there. Certainly, doctors don't want to have to say to patients, "Oh, you can have the shot, but you have to pay $200 to get it," or whatever it costs.

Brian: I think we have a caller with a very relevant experience, I think, from just this morning. Annette in Rockland County, you're on WNYC. Hi, Annette.

Annette: Hi. Oh, I'm so surprised. It's just going because I just came from CVS. I'm 90 years old, and they told me I can't have it without a prescription.

Brian: In Rockland County?

Annette: Rockland County.

Brian: You're 90 years old?

Annette: Yes.

Brian: What are you going to do?

Annette: I'm going to call the doctor and ask for a prescription.

Brian: There you go.

Annette: And go back.

Brian: Annette, thank you very much. Anecdotal evidence. Wow, a 90-year-old was turned away.

Caroline: Exactly. It sounds like they are sticking to the prescription requirement so far. It's definitely tough.

Brian: Here's another one. Flora in Manhattan, you're on WNYC. Hi, Flora.

Flora: Hi. Long-time listener. Huge fan. I tried to get a COVID vaccine in Manhattan. I'm 71 years old. CVS directed me to New Jersey. There are none in Manhattan at this time, even with a prescription. I signed up for Walgreens, and it said I needed a prescription, so I decided I was going to go over there and talk to the pharmacist, who was beyond overwhelmed, and said, "As of now, you need a prescription. I can't even read through all the pages of stuff they gave me. I don't have the time to deal. Get a prescription."

Then I said, "Will I be able to get another one in three months because I'm going on this huge cruise?" He said, "No, six months." Now I have to navigate when I want to get this COVID shot, for which event, two weddings or a cruise?

Brian: That part is at least standard. People have always been advised in the COVID era to time their shots for fairly close to when you're going to be in large groups of people.

Flora: Correct. It used to be four months. I used to get boosted again in four months. Now they're saying six.

Brian: Do you have reason to believe that you, as a New Yorker, can go to New Jersey and just get a shot there?

Flora: They're saying I can. They offered me on Warren Street in Jersey City, so I'm assuming I could have made an appointment.

Brian: There you go. All right. Manhattanites, get on the bath train, and you can get a COVID shot, it sounds like, if this is an issue for you. Again, Caroline, what a story. You know what other question it leads me to? I remember at the beginning of the pandemic, my primary care physician was offering shots in their office. You could go to the pharmacy like most people did, or in my case, I did go to a pharmacy for my first COVID vaccine, even back then, but I could have gone to my primary care physician's office. Are doctors' offices offering them so they can give the prescription and the shot at the same time, and then the doctor or the patient can submit it for insurance coverage?

Caroline: Certainly, many doctors' offices do offer COVID shots. I think the question is, like I said, this year, whether doctors will keep ordering them in the same amount, whether they'll want to invest in this, knowing that there might be spotty insurance coverage, and also feeling like, "Oh, maybe I can only offer this for select populations." I think there's some questions. Also, I know that, overwhelmingly, people do get their shots in pharmacies. I think the exception is often for young children who are already going to their pediatricians for their vaccines.

Brian: Let's see what's happening in the other state in our core listening area. Catherine, who's going to talk about getting a shot in Connecticut. Catherine, you're on WNYC. Hello.

Catherine: Hi, and thank you, Brian. We're on vacation through the end of September in Connecticut. We're from the Upper West Side. We know about the New York restrictions. Connecticut, no restrictions at CVS. No prescription needed. However, got to go online with them and find out which CVSs have it, not all. We're going over to Litchfield. That's where we're getting it. We're getting on the 19th of September. We're both elderly. I'm in my late 70s. My husband as well.

Brian: Catherine, thank you very much. Another example of how things are different from state to state. We just got a New York Times alert, even during our conversation, Caroline. This says California, Oregon, and Washington, so those three West Coast states are coordinating on vaccine advice, but it's not clear that will matter to insurance companies. It says other states might do the same. Maybe New York, New Jersey, and Connecticut, and maybe Massachusetts and Rhode Island and Vermont, New Hampshire, and Maine. Can we do the whole Northeast? Hello, Maryland, Delaware. Might form some kind of consortium, but in some ways, at least for the moment, it's another level of confusion.

Caroline: In New York, I reached out to the New York City Health Department, the State Health Department, and they basically said they are still trying to sift through all of this. I think it's really hard because they have issued no guidance so far to doctors or pharmacies. The City Health Department can also issue a standing order for vaccines for pharmacies, for instance, but they're not doing that yet. They're waiting to figure this all out. It's interesting because at the same time, the city put a statement up on X saying we're still following the science. We have no reason to believe that COVID shots aren't safe. Basically, they say they're working with colleagues around the country to figure this out and come up with their recommendations.

Brian: Any idea of when a clearer picture will emerge? Because if we established anything in this segment, it's that things are so different, state to state, pharmacy chain to pharmacy chain, maybe it's going to be doctor's office to doctor's office, and the federal government can clarify a lot. Will they, and when might a clearer picture emerge?

Caroline: I think we will start to have some more understanding after September 18th, which is when the Advisory Committee on Immunization Practices is set to meet. I think once we have that, we know that usually informs, like I said, insurance coverage, standing orders for pharmacies, state guidance. I think the question will be, how much does that diverge from the science that we have and the recommendations from other medical professional groups? Because then if it really does diverge a lot, then states will have to figure out, and doctors and pharmacies will have to figure out, "Am I going to keep following the recommendations from the CDC as we have, or are we going to start turning to other groups and following their recommendations?"

This is all happening while the Trump administration is completely overhauling the CDC. There's been an exodus of leaders there. They're reshaping what the central public health agency looks like in this country. Then if we get these recommendations and people aren't really going to follow them anymore, that's a huge shift in how public health and health care functions.

Brian: Oh, let me add one addendum question. Text that just came in. Listener asks, "Does this fiasco extend to flu shots?"

Caroline: The good news is flu shots are going to be administered and available pretty much as usual this year. The advisory committee I'm talking about, they did issue this guidance that the shots should not contain a certain preservative. I've talked to some doctors and professionals who say that was not really based on science, but it doesn't really affect us. They were basically like, "We can offer the shot without that preservative. It's fine." The flu shot should be available as usual.

Brian: We will leave it there for now. More to come, it seems. Thank you, Caroline Lewis, health care reporter for WNYC and Gothamist.

Caroline: Thanks, Brian.

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