COVID Vaccine Availability in the US

Authors: Katelyn Miyasaki, Yaneer Bar-Yam, Lani Boschulte

Physician Societies and States Move to Counter the Health Harms of Federal Policy Changes

The current administration, in particular the Department of Health and Human Services (HHS) under Robert F. Kennedy, Jr., has made major changes that depart from scientific consensus and established vaccination standards. One of these changes is the complete replacement of the Advisory Committee on Immunization Practices (ACIP), which has been the scientific advisory group to the CDC on immunization, replaced in June by a panel with known anti-vaccine sentiment [1]. Their recommendations have been widely used by states to guide vaccine policy.

Several major federal changes related to COVID-19 vaccines have been made by the new HHS:

• May: HHS announced that COVID-19 vaccines would no longer be recommended for healthy children or healthy pregnant women [2],  creating uncertainty around access and insurance coverage.
• August: The FDA approved updated 2025–2026 COVID-19 vaccines, but with narrower approval than in previous years: only for adults 65+ and individuals 6 months–64 years with underlying conditions.
• September: ACIP changed its recommendation from vaccination for everyone to “shared clinical decision-making,” requiring individual consultation with a healthcare provider. Shared clinical decision-making is a collaborative process where a patient and their healthcare provider work together to make a health decision. Healthcare providers in this context are defined by the CDC as “primary care physicians, specialists, physician assistants, nurse practitioners, registered nurses, and pharmacists” [3]. The CDC recently accepted these recommendations on Oct. 6th, but the delay caused some confusion as to what was actually available [4–6]. ACIP has also recommended other changes to the vaccination schedule, particularly for children. 

Taken together, these changes have created considerable uncertainty over who can and should be vaccinated, how vaccines should be accessed, and which vaccines will be covered by insurance. Consequently, these new federal policies introduce unnecessary and dangerous barriers to vaccination, going against the scientific and medical consensus on the importance of vaccines in protecting public health. 

Physician Societies and States Act to Protect Health and Vaccine Access

States set their own policies on vaccination, including school requirements, insurance coverage, and who may administer vaccines. However, many of these laws and guidelines have long referenced federal ACIP recommendations [7]. With ACIP replaced and federal guidance narrowing, states and medical societies are acting to preserve access to vaccines.

Physician medical societies: Physician societies are acting to sustain broad vaccine access, even as federal recommendations have become restrictive. The American Medical Association (AMA), joined by 79 other professional societies, released an open letter in June reaffirming support for vaccination to protect against respiratory diseases [8]. The American Academy of Family Physicians (AAFP) and the American Academy of Pediatrics (AAP) have also maintained their own vaccine schedule recommendations, which provide access for COVID-19 vaccines for everyone over 6 months of age [9,10].

Regional state collaboratives: Two regional groups of states have formed advisory collaboratives to develop their own public health policies, including vaccination. 

• West Coast Health Alliance (California, Hawaii, Oregon, and Washington) recommends all children over 6 months of age and all adults receive the updated 2025-2026 COVID-19 vaccine [11].
• Northeast Health Collaborative (Connecticut, Delaware, New Jersey, New York, Maryland, Massachusetts, Maine, Pennsylvania, Rhode Island and Vermont) similarly recommends that COVID-19 vaccines are accessible to all [12].
• Other states that have issued distinct policies from the federal government include: Arizona, New Mexico, Nevada, Colorado, Michigan, Wisconsin, Illinois, Minnesota, Kentucky, North Carolina, and Virginia. Washington, D.C. has also taken action.

Pregnancy: New HHS recommendations excluded pregnant people from COVID vaccines. This reflects a confusion about vulnerability: those most at risk—including mothers and their babies—are precisely the ones most strongly recommended to receive vaccines, since vaccines protect them from diseases known to cause serious harm in infants. The American College of Obstetrics and Gynecology (ACOG) strongly rejected this restriction and emphasized that vaccinations during pregnancy protect both mother and infant. Their position aligns with the American Academy of Pediatrics (AAP) and reflects the scientific evidence and long-standing scientific consensus on the benefits of maternal immunization [13]. 

Key issues

Who can be vaccinated?

Last year, COVID-19 vaccines were recommended for everyone over 6 months of age [14]. This year, federal guidelines have restricted eligibility: people under 65 without prespecified underlying conditions are no longer eligible for COVID-19 vaccines, per the vaccine labels. However, many states have restored access. Although details vary, many now recommend vaccination for all adults and children over 6 months, often by providing blanket prescriptions to all adults and through pediatricians and state services for children (i.e., a blanket prescription, also known as a standing order, is a single prescription issued by a state public health official). The most confusing part of the new policy is the conflict between restrictive federal guidelines and the more expansive rules set by many states. Here’s how to understand the difference and what it means for you.

– Federal Guidelines: These are the minimum eligibility rules set by the national government (HHS). Under the new policy, the federal government has narrowly defined who is eligible for a COVID-19 vaccine, limiting it to specific high-risk groups.

– State Guidelines: In the U.S. public health system, states have the authority to manage health and safety within their own borders. A state government can use this authority to issue its own rules that make vaccines available to a much broader population than the federal guidelines allow. Many states have done this, effectively overriding federal guidelines.

Please see the table below and resources from your state for the most up-to-date information. 

Who can administer vaccines?

Vaccine administration rules vary by state. Many states relied on ACIP’s recommendations to authorize pharmacists to provide vaccines—which is important for making vaccines widely available. In August, many pharmacies, including CVS and Walgreens, stopped administering COVID-19 vaccines due to state guidelines [15]. Since then, many states have removed restrictions by either directly authorizing pharmacists to administer COVID-19 vaccines or by referencing physician societies instead of ACIP [2].

Will insurance pay for vaccinations?

Due to the changes in federal policies, both the public and states have raised concerns about whether insurance companies will continue to cover the cost of vaccinations—without which many people could lose access. The private insurance association AHIP announced that all vaccines eligible as of September 1 will be covered through the end of 2026, including the updated 2025–2026 COVID-19 and flu vaccines [16,17]. This means that people with private insurance who are eligible can be vaccinated free of charge [18]. 

Furthermore, some states are requiring insurers to pay for COVID vaccines, and individual insurers may choose to cover vaccines more broadly than federal policy requires [18].

Where to find more information

• Dr. Lucky Tran regularly posts public health news on Twitter/X and Bluesky, and is maintaining an updated map of state actions to protect vaccine access. 
• Scientific American and KFF have released clear summaries and ongoing reports on state-level policies.
• The Common Health Coalition is regularly updating their vaccine information page here: 

Taking action 

The recent actions taken by states to preserve vaccine accessibility and protect public health demonstrate that state law can play a decisive role in shaping health measures. With policies changing rapidly, there is a key opportunity to influence their direction. By reaching out now to state executives, public health agencies, and your state and local representatives, you can help shape policies on public health and vaccine access.

State actions for vaccine access

Notes indicate states that have taken specific actions. Empty rows mean no clear state-level action has been reported. Vaccine availability in those states may still follow federal policy or existing laws. Please confirm with local sources for the latest information. (Last updated Oct 3, 2025) 

1. Stobbe M. CDC ACIP vaccine committee replacements named by Robert F. Kennedy Jr. In: AP News [Internet]. 11 Jun 2025 [cited 6 Oct 2025]. Available: https://apnews.com/article/cdc-acip-vaccine-committee-9f58e1f004075b081718ff078de88d76

2. Kates J, Bell C, Michaud J, Williams E, Tolbert J. Tracking state actions on vaccine policy and access. In: KFF [Internet]. 24 Sep 2025 [cited 6 Oct 2025]. Available: https://www.kff.org/covid-19/tracking-state-actions-on-vaccine-policy-and-access

3. CDC. ACIP shared clinical decision-making recommendations. In: Advisory Committee on Immunization Practices (ACIP) [Internet]. 6 May 2025 [cited 15 Oct 2025]. Available: https://www.cdc.gov/acip/vaccine-recommendations/shared-clinical-decision-making.html

4. Stein R. The CDC still hasn’t issued COVID vaccine guidelines, leaving access in limbo. NPR. 2 Oct 2025. Available: https://www.npr.org/sections/shots-health-news/2025/10/02/nx-s1-5559439/cdc-covid-vaccine-guidelines. Accessed 6 Oct 2025.

5. CDC. CDC immunization schedule adopts individual-based decision-making for COVID-19 and standalone vaccination for chickenpox in toddlers. In: CDC Newsroom [Internet]. 6 Oct 2025 [cited 6 Oct 2025]. Available: https://www.cdc.gov/media/releases/2025/cdc-immunization-schedule-adopts-individual-based-decision.html

6. Jetelina K, Totte H. The shutdown’s impact on health, RSV is stirring, Covid-19 vaccines finally given green light, deadly pasta outbreak, and lots of good news! In: Your Local Epidemiologist [Internet]. 6 Oct 2025 [cited 6 Oct 2025]. Available: https://yourlocalepidemiologist.substack.com/p/the-shutdowns-impact-on-health-rsv

7. ASTHO. Impact of the Advisory Committee on Immunization Practices Recommendations on State Law. In: Association of State and Territorial Health Officials [Internet]. 23 Jun 2025 [cited 6 Oct 2025]. Available: https://www.astho.org/topic/resource/impact-of-acip-recommendations-on-state-law/

8. American Medical Association. AMA, 79 medical societies back vaccination against respiratory viruses. In: American Medical Association [Internet]. 25 Jun 2025 [cited 6 Oct 2025]. Available: https://www.ama-assn.org/press-center/ama-press-releases/ama-79-medical-societies-back-vaccination-against-respiratory

9. AAP Immunization Schedule. In: AAP Publications [Internet]. 17 Sep 2025 [cited 6 Oct 2025]. Available: https://publications.aap.org/redbook/resources/15585

10. Immunization schedules. 28 Aug 2025 [cited 6 Oct 2025]. Available: https://www.aafp.org/family-physician/patient-care/prevention-wellness/immunizations-vaccines/immunization-schedules.html

11. McNamara M. West Coast Health Alliance issues vaccine recommendations. 2025. Available: https://www.khq.com/news/west-coast-health-alliance-issues-unified-vaccine-recommendations/article_5e52017a-0765-453b-9558-d00a515bf098.html

12. Northeast Public Health Collaborative recommendations for the 2025-2026 COVID-19 vaccine. 2025. doi:10.1542/peds.2025-073924/203222/Recommendations-for-COVID-19-Vaccines-in-Infants?autologincheck=redirected

13. ACOG releases updated maternal immunization guidance for COVID-19, influenza, and RSV. [cited 7 Oct 2025]. Available: https://www.acog.org/news/news-releases/2025/08/acog-releases-updated-maternal-immunization-guidance-covid-influenza-rsv

14. Panagiotakopoulos L, Moulia DL, Godfrey M, Link-Gelles R, Roper L, Havers FP, et al. Use of COVID-19 vaccines for persons aged ≥6 months: Recommendations of the Advisory Committee on Immunization Practices – United States, 2024-2025. MMWR Morb Mortal Wkly Rep. 2024;73: 819–824. doi:10.15585/mmwr.mm7337e2

15. Frazier K. CVS and Walgreens limit access to COVID vaccines as required by some state guidelines. In: CBS News [Internet]. 29 Aug 2025 [cited 8 Oct 2025]. Available: https://www.cbsnews.com/news/cvs-walgreens-limit-access-covid-vaccines-required-state-guidelines/

16. Stephanie Soucheray MA. Insurance trade group says COVID, flu vaccines covered through 2026. [cited 8 Oct 2025]. Available: https://www.cidrap.umn.edu/covid-19/insurance-trade-group-says-covid-flu-vaccines-covered-through-2026

17. AHIP statement on vaccine coverage. In: AHIP [Internet]. 16 Sep 2025 [cited 8 Oct 2025]. Available: https://www.ahip.org/news/press-releases/ahip-statement-on-vaccine-coverage

18. Seaton J. COVID vaccine access now varies from state to state. Here’s what to know. Scientific American. Available: https://www.scientificamerican.com/article/covid-vaccine-access-now-varies-from-state-to-state-heres-what-to-know/. Accessed 8 Oct 2025.