As COVID cases increase, so does confusion about vaccine recommendations

Kansas News Service

The CDC has already changed some vaccine guidelines, and the FDA may change others, which could throw insurance coverage into question and lead to fewer people getting shots.

As students head back to school, COVID-19 rates are ticking up in the Kansas City area.

But this year it may not be quite so clear-cut who should roll up a sleeve for an updated dose of the COVID vaccine.

Recent changes in recommendations from the U.S. Centers for Disease Control and Prevention have caused uncertainty about who will be able to get an updated dose this year — and potentially whether insurance will pay for it.

Kansas City-area doctors and public health leaders, though, said their advice hasn't changed.

"We still firmly stand behind vaccination as being the best preventative intervention to COVID," said Ginny Boos, director of infection prevention for BJC Health System West, which includes Kansas City's St. Luke's Health System. "We recommend that people get vaccinated."

Since COVID vaccinations became available at the end of 2020, recommendations have been relatively consistent. Most people needed a COVID shot each fall when vaccine makers released a new formulation. Older people and those with health conditions that could put them at higher risk if they were infected with the virus often were advised to get a second dose.

But under the leadership of U.S. Health Secretary Robert F. Kennedy Jr., those recommendations have already changed — and could be changed more.

In May, the CDC stopped recommending the annual vaccine for children and pregnant women, something physician academies in both practice areas have pushed back on.

And when the Food and Drug Administration licenses this year's COVID vaccine, there is speculation that the labeling information will limit its recommended use to adults 65 and over and people who are at high risk.

Marvia Jones, director of the Kansas City Health Department, said if that change is made it could affect which vaccines insurance plans will cover. If people are told they no longer meet the criteria to qualify for the vaccine, they could be looking at paying hundreds of dollars out of pocket for it.

"That could be a problem for people who wanted it but can't afford to pay for it," she said.

While public health departments can provide some vaccines, funding for those supplies are more limited this year because of federal funding cuts.

Jones said Kansas City's health department has ordered 1,000 doses that will be available for free or on a sliding fee scale. But she worries that many people just won't bother with the vaccine this year.

Demand for COVID vaccine already low

Demand for the shots has been falling off since the COVID vaccine was initially introduced.

While 68% of Missourians and 75% of Kansans have had at least one dose of the COVID vaccine, the number of people getting recommended follow-up vaccines is significantly smaller.

In Missouri, only 58% of the population is fully vaccinated (typically two initial shots), while only 26% percent had received additional doses as of fall 2022. In Kansas, 64% of the population is fully vaccinated and 30% had received an additional shot in the same timeframe.

Notably, those participation numbers represent what was happening before people had to pay anything for shots. Last year was the first year the federal government didn't pick up the tab, so free shots went away.

Commercial and public insurance plans continued covering the vaccines, often without a copay. But many health experts worry that could change if federal vaccine guidelines stop recommending the annual dose.

In a written statement, Tina Stow, a spokesperson for AHIP, a health insurance industry trade association, said health plans would cover vaccines recommended by the federal Advisory Committee on Immunization Practices, which determines government-recommended vaccine schedules.

"Health plans continue to follow federal requirements related to coverage of ACIP-recommended vaccines and will continue to support broad access to critical preventive services, including immunizations," Stow's statement said.

In June, Kennedy dismissed members of that advisory committee and began appointing replacements, some of whom are known vaccine skeptics.

For now, the ACIP still recommends that adults 18-64 get an annual COVID vaccine, with additional doses for older, at-risk individuals. For children 6 months to 17 years old, the new recommendation is for doctors and parents to work together to decide if children should receive an annual dose.

"Where the parent presents with a desire for their child to be vaccinated," the CDC guidelines say, "children 6 months and older may receive COVID-19 vaccination, informed by the clinical judgment of a health care provider and personal preference and circumstances."

Most severe disease 'at the extremes of ages'

On Aug. 19, the American Academy of Pediatrics released its own vaccine recommendations for children in response to the CDC's changed schedule. Most significantly, the organization added the recommendation that children 6 months to 2 years old receive the vaccine.

"That's really important, because we know that the most severe disease happens at the extremes of ages," said Dr. Angela Myers, a professor of pediatrics in the division of infectious diseases at Children's Mercy Hospital. "All children under 2 years of age really need to be immunized to be safe."

But young children may soon lose their only COVID vaccine option. According to recent reporting in The New York Times, the FDA is considering ending authorization of the Pfizer vaccine for use in children under 5 years old. It is currently the only option for that age group.

Myers, who is a member of the American Academy of Pediatrics committee that voted on the vaccine recommendations, said older children who have already been vaccinated, don't have health complications and don't live with family members with complications have more leeway to skip the annual dose.

But everyone should have the ability to get one if they want to, she said, and insurance should cover it.

Myers advises any parent considering whether to get their children this year's dose to talk it over with their doctor.

"Even if you don't feel like you or your family have any risk factors, it's still a worthy conversation to have," she said. "It absolutely provides protection and also peace of mind for some."

The reformulated dose should be available at Children's Mercy and in some doctors' offices in the next few weeks. Health departments and drug stores like Walgreens and CVS also typically offer the shot.

It has been common since the start of the pandemic for cases to spike twice a year — usually in the winter and again in late summer.

Of course, the disease is nothing like it was before vaccines were available and when most people lacked immunity. At the height of the pandemic, around the beginning of 2021, weekly deaths from the virus reached almost 26,000. During the week of Aug. 9, the CDC reported 87 deaths due to COVID.

But there are still reasons people should avoid getting the virus, said Dr. Dana Hawkinson, an infectious-disease doctor at the University of Kansas Health System.

"We have to understand that there is a significant amount of population and individual immunity," he said. "However, we also have to understand that this continues to be a disease which can cause morbidity and mortality."

When deciding whether to get vaccinated this fall, people need to consider their own risk factors, including their age and health conditions, which could make them more susceptible to severe illness. They also need to consider their family members' risk factors. If someone you live with is older or has an illness that makes them more vulnerable to the virus, you should consider getting an updated vaccine.

People should also realize that getting a vaccine will help reduce the chances that someone will get long COVID, symptoms caused by the virus that can linger for months and years and can be difficult to treat.

"That can significantly affect people," Hawkinson said. "It can affect their quality of life, their daily living. It can affect work and therefore income … and we know that vaccination as a whole and in general does reduce the chance or risk for long COVID symptoms."

Already infections from the virus are ticking up in Kansas City and in other parts of the country. The Kansas City Health Department data, based on wastewater monitoring and reported positive tests, show three consecutive weeks of growing infections.

And according to CDC data, for the week of Aug. 9 Kansas reported a 41.8% increase in the percentage of emergency department visits with diagnosed COVID. Missouri does not report that data.

Health care providers said the increase is more of a reflection of low rates in previous weeks than a significant wave of people showing up in emergency departments with COVID. But most doctors said it's still a good reminder that it might be time to get another shot.

Dr. David M. Bamberger, an infectious disease doctor at University Health, said if people can't get access to the new formulation of the COVID vaccine, or worry their insurance won't cover the shot once the new coverage year begins and don't want to risk waiting for the new dose, getting last year's vaccine could also be a good option.

For more information visit KCUR.org.