A pharmacy in Brooklyn, N.Y., this month advertises Covid testing and the vaccine.Spencer Platt / Getty Images

Healthy kids and adults looking for an updated Covid shot this fall may have a tougher time getting it.

On Friday, a Centers for Disease Control and Prevention advisory panel unanimously recommended limiting the Covid shot to people 65 and older or those with underlying health conditions, based on an individual decision or with their doctor. The panel rejected a separate recommendation that the agency should encourage states to require a prescription.

People under 65 are advised to consult with their doctor, the panel said, with "an emphasis that the risk-benefit of vaccination is most favorable for individuals who are at an increased risk for severe COVID-19 disease."

The recommendation -- if cleared by acting CDC Director Jim O'Neill -- narrows the agency's earlier stance, which called for the shot to be offered to everyone 6 months and older.

The panel chose not to take a vote on whether to recommend the shot for pregnant women, deferring the decision to CDC officials, Retsef Levi, a member of the advisory committee, said during the meeting.

Friday's recommendation aligns with the Food and Drug Administration's approval in August, which cleared the shots for people 65 and up and those with underlying health conditions. Over the last few weeks, people in some states have reported frustration in getting access to the shots, as pharmacies awaited official guidance from the CDC's advisory committee.

The decision by the agency's Advisory Committee on Immunization Practices (ACIP) comes after the panel moved on Thursday to restrict access to a measles-mumps-rubella vaccine known as MMRV. The panel also postponed a vote on whether all newborns should get the hepatitis B shot.

The 12 ACIP members who voted Thursday and Friday were handpicked under Health Secretary Robert F. Kennedy Jr. after he dismissed the previous panel in June. Some of the new members are known anti-vaccine activists.

The discussion Friday included a number of fringe ideas promoted by anti-vaccine groups, including claims that injuries caused by the Covid vaccines aren't being well documented or that the shots can lead to cancer or birth defects -- assertions not supported by scientific evidence.

During the meeting, outside medical groups and organizations urged the agency to keep its recommendation unchanged.

"It's important to note that we continue to see severe disease from Covid-19, leading to hospitalizations and deaths," said Dr. Robert Hopkins Jr., the medical director of the National Foundation for Infectious Diseases. "The impact is greatest in our population 75 and older but is also significant in our younger adults and also our youngest children."

Since October 2024, the CDC estimates the virus has led to hundreds of thousands of hospitalizations and 42,000 to 60,000 deaths nationwide, largely in older adults.

"Any decrease in vaccination coverage in older adults will lead to more hospitalizations and death in this age group," said Dr. Fiona Havers, an infectious diseases physician and former medical epidemiologist at the CDC.

The recommendation, experts say, is likely to create roadblocks for people who want to get a Covid shot this fall but are left out of ACIP's eligible groups.

In many states, pharmacists can only give Covid shots if they follow ACIP's guidelines, and going outside those recommendations can land them in legal trouble, said Dorit Reiss, a vaccine policy expert at the University of California Law, San Francisco. Some states -- including California and Oregon -- have sought to get around this and ensure access by setting their own guidance on vaccines for respiratory illnesses like Covid.

The CDC presented data Friday that found about two-thirds of adults who received a Covid shot last year got it at a pharmacy.

Major pharmacy chains, including CVS and Walgreens, said they were holding off on giving the shots -- or requiring a prescription -- as they awaited the CDC's official guidance.

Pharmacists, Reiss said, generally have fewer legal protections compared to doctors and hospitals, so most are hesitant to step outside the CDC's recommendations.

The panel on Friday didn't specify which medical conditions put a person at a higher risk of severe illness. However, the CDC website lists dozens of conditions either linked to or suggestive of higher risk, including asthma, cancer, heart conditions, diabetes, obesity, pregnancy, depression, Down syndrome and autism.

People who don't fall into the eligible groups may still be able to get a Covid shot from a doctor's office or at a hospital.

Doctors can still offer the vaccine off label, referring to the practice of prescribing a medication for a different purpose than what the FDA has approved it for.

The health insurance industry's trade group AHIP has also pledged that insurers will keep covering the shots ACIP had recommended before this week's meeting. Previously, the panel recommended the Covid shot for everyone 6 months and older.

What this means for people outside AHIP plans -- like Medicaid enrollees -- isn't yet clear, although an HHS spokesperson said they should have coverage.

Medicare, Reiss said, has its own guidelines outside of ACIP and can decide to keep covering the shots for people 65 and older.

The two-day CDC meeting marks what experts say is the beginning of Kennedy Jr.'s drive to overturn the long-established childhood vaccine schedule.

The mRNA vaccines are a particular target among anti-vaccine activists. The vaccines from Pfizer and Moderna are the first-ever approved using mRNA technology, which has led some to claim they pose a unique threat.

Florida Surgeon General Joseph Ladapo has railed against mRNA vaccines, alleging they could possibly alter a person's DNA. Several states have introduced legislation that would ban mRNA vaccines. The CDC says the mRNA Covid vaccines are safe and do not alter DNA; the technology had been studied for decades before its first approval in the U.S. in late 2020.

CDC panel votes to limit who is eligible for this fall's Covid vaccine