During the first half of September, even people who met those criteria faced significant obstacles to getting a shot. The new recommendations appeared likely to expand access but still potentially leave gaps.

Medical experts emphasize that, while hospitalizations and deaths have greatly decreased from past years, COVID is still spreading -- and while some groups are at higher risk, no one is guaranteed to have a mild infection. Many disagree with the Trump administration's approach and support Americans at large doing their best to get a vaccine.

In theory, anyone 6 months or older should be able to get an updated COVID shot this fall. But the government's guidance is written in such a way that, for some people, access may be difficult in practice.

In August, the FDA limited eligibility to people who are 65 and older, or who are 6 months to 64 years with at least one medical condition that puts them "at high risk for severe outcomes from COVID-19." The list of such conditions is long -- it includes asthma, cancer, obesity and being immunocompromised, as well as less obvious things like physical inactivity -- but those criteria still left millions of Americans ineligible.

But now, the CDC's vaccine advisory panel, which Kennedy purged in June and appointed handpicked members to, has approved a set of recommendations suggesting that people outside those categories could get shots in consultation with a medical professional.

Those recommendations say the vaccines should be available to people 65 and older based on "shared clinical decision-making," and to younger people on the same basis but "with an emphasis that the risk-benefit of vaccination is most favorable for individuals who are at an increased risk" for severe disease. In other words, the panel is saying the case for vaccination is strongest in the groups the FDA identified, but it is not forbidden for other people to get vaccinated.

They also call for "more consistent and comprehensive informed consent processes," but do not say what those processes should consist of, and urge "authorized health care providers" to "discuss the risks and benefits of the vaccination for the individual patient."

None of this language is particularly clear, legal experts said. Different providers might interpret it in different ways and come to different decisions about who can get a shot.

For example, even the CDC panelists who voted for the recommendations expressed uncertainty about what they meant for pharmacists' ability to administer vaccines.

The CDC has said "primary care physicians, specialists, physician assistants, nurse practitioners, registered nurses and pharmacists" can provide shared clinical decision-making, which refers to a discussion between a provider and a patient about whether a given vaccine or treatment is appropriate. But Richard Hughes IV, a vaccine lawyer who teaches at George Washington University Law School and worked for Moderna, said state laws differed as to pharmacists.

In past years, COVID vaccines were approved for all Americans 6 months and older.

How can I get a vaccine?

Availability may differ from state to state, so the best way to confirm is to contact your doctor or pharmacy. But some general information is available.

Before the CDC panel voted, CVS and Walgreens, the nation's two largest pharmacy chains, were requiring prescriptions in some states because of laws forbidding pharmacists to administer vaccines in the absence of a recommendation from the panel.

But if the head of the CDC adopts the panel's recommendations, CVS will start providing the shots without prescriptions nationwide, including to people outside the FDA-approved groups, according to a CVS spokesperson, Amy Thibault.

Walgreens did not immediately confirm what it would do.

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The question of whether pharmacists can provide "shared clinical decision-making" has an enormous effect on access, because in past years, the vast majority of Americans received their COVID shots at pharmacies, said Katelyn Jetelina, a public health researcher who writes the newsletter "Your Local Epidemiologist." And it is possible that different pharmacies' lawyers will come to different conclusions.

Doctors can indisputably provide the vaccines: It is legal and common for them to prescribe medications off-label, meaning for uses the FDA hasn't approved. But there is no guarantee that your doctor will do so, or that they'll have vaccines in stock, since many are used to relying on pharmacies to provide them.

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Will pharmacies require proof that I have a high-risk condition?

It may depend on the pharmacy and the state.

Assuming the CDC panel's recommendations are formally adopted, CVS said it would not require proof of any condition, or even self-attestation of one. "It's up to the individual patient," Thibault said. "Our pharmacists will answer any questions patients have about the vaccine and administer it."

It is not yet clear whether Walgreens or other pharmacies will do the same. Currently, in states where it has made COVID shots available, Walgreens is allowing patients to click a button saying they qualify, and is not officially requiring documentation to prove they are telling the truth. Some patients have reported being asked for proof by individual pharmacists, though.

Other chains' and independent pharmacies' policies may vary.

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In general, if a pharmacist feels "that their license is at any risk, they're not going to vaccinate," Spreeha Choudhury, a lawyer and former pharmacist, said before the CDC panel made its recommendations. But CVS' decision is an early indication that more pharmacists may vaccinate now than before the panel voted.

AHIP, a national trade organization for health insurers, said this week that its members would cover all vaccines that were CDC-recommended as of Sept. 1, including COVID vaccines, through at least the end of 2026 -- a striking declaration of intent to ignore any changes the CDC panel made. That pledge applies to a long list of insurers. And one company that isn't part of AHIP, UnitedHealthcare, confirmed to The New York Times that it would continue to cover all shots that were recommended as of the beginning of 2025.

The Department of Health and Human Services also released a statement saying that the CDC panel's recommendations allowed coverage through all government-run health care programs, including Medicaid, Medicare and Vaccines for Children.

Still, there are some private insurers that haven't made their intentions clear, and plans in a category called "self-funded" sometimes set rules that differ from their parent company's.

Under the Affordable Care Act, almost all insurers must fully cover vaccines that the CDC panel recommends. But it isn't clear whether that requirement applies to vaccines recommended with the shared clinical decision-making caveat, said Dorit Reiss, a professor at UC Law San Francisco. (Even if insurers aren't required to cover a vaccine, though, they may choose to do so, as many have.)

My state changed its vaccine policies. Does that make a difference?

It could.

Two sets of states -- one on the West Coast and one in the Northeast -- have formed alliances to make vaccine recommendations independent of the FDA and CDC. A number of states, both within and outside those alliances, have also issued policies in recent weeks authorizing pharmacists to administer COVID shots even if state law would otherwise preclude it.

In those states, there may be less confusion and more widespread access to COVID shots. The disparity in access between states is likely to be smaller than it was before the CDC panel made its recommendations, though.

When is the best time to get the shot?

Late September through October, experts said. That gives the shot time to take effect before a winter wave is expected.

The exception is if you had COVID recently. For maximum efficacy, wait three months after a COVID infection before getting a vaccine.

It is a good idea to get your flu shot at the same time, and your RSV shot if you're in a vulnerable population, said Dr. Megan Ranney, an emergency physician and the dean of the Yale School of Public Health.

Can I get a vaccine if I'm pregnant?

If you're pregnant, you are among the people for whom vaccination is most important, Ranney said.

Organizations like the American College of Obstetricians and Gynecologists recommend the COVID shot because of evidence that pregnancy increases the risk of severe illness, that COVID can harm fetuses and that vaccines during pregnancy can protect infants.

Access has been complicated by contradictory federal policies: Pregnancy is on the CDC's list of high-risk conditions, but the agency has stopped recommending COVID vaccines during pregnancy. Your access may depend on the discretion of individual doctors.

Can children be vaccinated?

The FDA approved Moderna's newest vaccine for children 6 months and older who have at least one high-risk condition. It approved Pfizer's vaccine only for children 5 years and up, and Novavax's only for children 12 and up, in both cases also with the high-risk limitation. The CDC recommendations may ease access for healthy children, but the age minimums for each shot remain.

It can also be very difficult to find a pharmacy that has the vaccine in stock in the child dosage, and some pediatricians' offices are choosing not to carry it, assuming that pharmacies will provide access.

The FDA's decision to restrict approval angered some medical experts, because children younger than 2 experience some of the highest rates of severe illness from COVID even if they are otherwise healthy. The American Academy of Pediatrics broke with federal health officials to recommend COVID vaccination for all children 6 months to 2 years old.

The shot should provide substantial protection against severe illness through the full winter virus season, said Dr. Paul Sax, the clinical director of infectious diseases at Brigham and Women's Hospital.

Protection against being infected at all is likely to wane within a couple of months, he said, and even at its peak, the vaccine reduces but doesn't eliminate risk.

What are the side effects?

Many people will have a sore arm or flu-like symptoms. These symptoms should clear up in a day or two.

Can you still get the COVID shot? - The Boston Globe