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New Trump vaccine policy limits access to COVID shots
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Published May 20, 2025 Ā ā¢Ā 4 minute read
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A pharmacist holds a COVID-19 vaccine at a pharmacy in New York, on Tuesday, Sept. 24, 2024. Photo by Mary Conlon /THE ASSOCIATED PRESSWASHINGTON ā The Trump administration said Tuesday it will limit approval for seasonal COVID-19 shots to seniors and others at high risk pending more data on everyone else ā raising questions about whether some people who want a vaccine this fall will be able to get one.
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Top officials for the Food and Drug Administration laid out new requirements for access to updated COVID shots, saying theyād continue to use a streamlined approach to make them available to adults 65 and older as well as children and younger adults with at least one high-risk health problem.
But the FDA framework, published Tuesday in the New England Journal of Medicine, urges companies to conduct large, lengthy studies before tweaked vaccines can be approved for healthier people. In the paper and a subsequent online webcast, the FDAās top vaccine official said still, more than 100 million Americans still should qualify for what he termed a booster under the new guidance.
Dr. Vinay Prasad described the new approach as a ācompromiseā that will allow vaccinations in high-risk groups while generating new data about whether they still benefit healthier people.
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āFor many Americans we simply do not know the answer as to whether or not they should be getting the seventh or eighth or ninth or tenth COVID-19 booster,ā said Prasad, who joined the FDA earlier this month. He previously spent more than a decade in academia, frequently criticizing the FDAās handling of drug and vaccine approvals.
Itās unclear what the upcoming changes mean for people who may still want a fall COVID-19 shot but donāt clearly fit into one of the categories.
āIs the pharmacist going to determine if youāre in a high-risk group?ā asked Dr. Paul Offit, a vaccine expert at Childrenās Hospital of Philadelphia. āThe only thing that can come of this will make vaccines less insurable and less available.ā
The nationās leading pediatrics group said FDAās approach will limit options for parents and their children.
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āIf the vaccine were no longer available or covered by insurance, it will take the choice away from families who wish to protect their children from COVID-19, especially among families already facing barriers to care,ā said Dr. Sean OāLeary of the American Academy of Pediatrics.
Provisional data from the Centers for Disease Control and Prevention shows more than 47,000 Americans died from COVID-related causes last year. The virus was the underlying cause for two-thirds of those and it was a contributing factor for the rest. Among them were 231 children whose deaths were deemed COVID-related, 134 of them where the virus was the direct cause ā numbers similar to yearly pediatric deaths from the flu.
The new FDA approach is the culmination of a series of recent steps under Health Secretary Robert F. Kennedy Jr. scrutinizing the use of COVID shots and raising major questions about the broader availability of vaccines. It was released two days ahead of the first meeting of FDAās outside vaccine experts under the Trump administration.
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Last week the FDA granted full approval of Novavaxās COVID-19 vaccine but with major restrictions on who can get it ā and Tuesdayās guidance mirrors those restrictions. The approval came after Trump appointees overruled FDA scientistsā earlier plans to approve the shot without restrictions.
Pfizer and Moderna, makers of the most commonly used COVID shots, each said they would continue to work with the agency.
For years, federal health officials have told most Americans to expect annual updates to COVID-19 vaccines, similar to the annual flu shot. Just like with flu vaccines, until now the FDA has approved updated COVID shots so long as they show as much immune protection as the previous yearās version.
But FDAās new guidance appears to be the end of that approach, according to Prasad and FDA Commissioner Marty Makary, who co-authored the journal paper and joined the FDA webcast.
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Prasad and Makary criticized the U.S.ās āone-size-fits-all,ā contrasting it with some European countries that recommend boosters based on age, risk and other factors.
Prasad said the FDA will ask all manufacturers to do a new clinical trial in healthy people ages 50 to 64, randomly assigning them to get a vaccine or a placebo and tracking outcomes with special attention to severe disease, hospitalization or death. He said such a study might need to be repeated if thereās a large virus mutation rather than the past yearās incremental evolution. Companies are also free to test their vaccines for approval in younger adults and children, Prasad said, adding āthis is a free country.ā
Since becoming the nationās top health official in February, Kennedy has filled the FDA and other health agencies with outspoken critics of the governmentās handling of COVID shots, particularly their recommendation for young, healthy people. Under federal procedures, the FDA releases new guidance in draft form and allows the public to comment before finalizing its plans. The publication of Tuesdayās policy in a medical journal is highly unusual and could run afoul of federal procedures, according to FDA experts.
Health experts say there are legitimate questions about how much everyone still benefits from yearly COVID vaccination or whether they should be recommended only for people at increased risk.
In June, an influential panel of advisers to the CDC is set to debate which vaccines should be recommended to which groups.
The FDAās announcement appears to usurp that advisory panelās job, Offit said. He added that CDC studies have made clear that booster doses do offer protection against mild to moderate illness for four to six months after the shot even in healthy people.
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