Amid chaos at the CDC, how should patients navigate vaccinations?

Amid high-profile firings and resignations at the Centers for Disease Control and Prevention — plus new restrictions on COVID-19 vaccinations — local health officials in Philadelphia say consumers should work with their doctors to navigate an uncertain environment around vaccinations for both children and adults.

The murky situation grew still more complex late in the week with the news that both CVS and Walgreens, drugstores where many Americans get their shots, are scaling back their COVID-19 vaccine offerings in some states until the regulatory picture gets clearer.

CVS said Friday that in 13 states, including Pennsylvania, it will require a prescription for COVID-19 vaccines until the CDC formally recommends updated COVID shots, the New York Times reported. In three states, the vaccine would not be available, the company said. Walgreens also required prescriptions in several states, the Times reported, based on attempts by reporters to book shots there.

It can be hard to get the vaccine at medical practices because many offices do not stock the temperature-sensitive product, making the chain pharmacies critical to vaccination efforts.

Earlier this week, the Food and Drug Administration, in a departure from recent years, announced that it would approve this fall’s updated COVID vaccines only for people over 65 and adults with underlying medical conditions that put them at higher risk of the virus. Children under 18 can get the vaccine after consulting with a doctor.

The move came after Health and Human Services Secretary Robert F. Kennedy Jr., a longtime anti-vaccine campaigner, fired the entire Advisory Committee on Immunization Practices, replacing the CDC’s expert group with a handpicked roster that included some vaccine skeptics.

And on Wednesday, the White House fired CDC director Susan Monarez, saying she did not align with the administration’s priorities. The Associated Press reported that, among other clashes with Kennedy, she had refused to unquestioningly sign off on recommendations from the reconstituted ACIP.

Still, health officials in Philadelphia say they are working to vaccinate the city’s children as they monitor a chaotic and changing situation in federal health agencies.

“We focus on the mission of keeping children protected through immunizations, come what may, and we deal with each change as it comes,” said Mayassa Abuali, medical director of the Philadelphia Immunization Program, in an interview last week.

Paul Offit, a nationally renowned vaccine expert and physician who leads Children’s Hospital of Philadelphia’s Vaccine Education Center and serves on an FDA vaccine advisory committee, said the moves at the CDC and FDA are highly unusual and bypass traditional processes for approving vaccines.

He said his advisory panel was not consulted on the FDA’s decision to approve COVID shots only for certain groups.

Typically, Offit said, the FDA permits pharmaceutical companies to sell a product, and the CDC makes recommendations on who can receive it. In licensing COVID vaccines only for certain groups, Offit said, “the FDA has usurped the CDC’s position.”

In an environment where public health positions are increasingly politicized, Offit said, the public may instead lean on recommendations from professional medical groups outside the federal government, like the American Association of Pediatrics.

Earlier this year, the CDC announced that it would no longer recommend COVID vaccines for healthy children and pregnant women, saying instead that parents of healthy children can make individual decisions with their doctors about whether to give kids 6 months and up a COVID vaccine.

In response, the AAP recently released its own set of recommendations, saying parents should get children under 2 vaccinated for COVID.

“I no longer trust the CDC. I no longer trust ACIP. Now we turn to professional societies to get science-based recommendations,” Offit said.

It is difficult to predict the actions of the reconstituted ACIP when it meets next month, making it tough for public health officials to plan ahead.

The committee has indicated that at its next meeting, set for Sept. 18 and 19, members will discuss recommendations on hepatitis B vaccines, which are typically given at birth, and measles, mumps, rubella, and chickenpox vaccines, raising additional concerns for some vaccine experts.

One told NPR that, by reexamining vaccine recommendations that have been in place for years, the committee could revisit “long-settled questions” and lend credibility to anti-vaccine advocates.

It is also unclear how the committee will treat updated COVID vaccines. The FDA restricting approval to certain groups is “the first step in learning what the ultimate recommendations for this fall will be, and we are waiting for more information from ACIP and, ultimately, the CDC,” James Garrow, a spokesperson for the Philadelphia Department of Public Health, said in a statement.

“There are still many outstanding questions about who is ultimately recommended to receive [COVID-19 vaccines]. Our recommendations continue to be that everyone who is eligible to receive a vaccine should get it,” he said.

Philadelphians should talk to their doctors about their risk for COVID, Garrow said, and the city is particularly interested in increasing vaccinations for adults over 65 this fall. The FDA approved the latest vaccines for that group.

Charlotte Moser, the codirector of the Vaccine Education Center — and one of the fired members of ACIP — said that, because the CDC currently recommends that parents consult doctors before getting healthy children vaccinated, parents should still be able to get COVID vaccines for their kids after a doctor’s visit.

But, she said, it is unclear whether the chaotic situation at government health agencies could affect vaccine supply as insurers and pharmaceutical companies navigate shifting recommendations.

“This confusion is because the federal policy is no longer being informed by scientific data,” she said.

Abuali said the city health department is committed to keeping Philadelphia’s children up-to-date on vaccines, and is encouraged by recent increases in standard childhood immunizations that had fallen during the COVID-19 pandemic.

Research shows that most Americans trust their primary-care physicians above all other information sources when it comes to vaccines, she said, and Philadelphians should consult their doctors for help in confusing times.

“I believe in that powerful connection between physician and patient, and I believe that we can continue to make a difference again, despite all the noise around us now,” Abuali said. “As changes come, we’ll deal with them by continuing to use science.”

Moser said it is also important for the vast majority of American parents who do vaccinate their children — 99 out of every 100 kids get some vaccines by age 2, she said — to speak up.

“People who have the power to make a change here are elected officials. If families aren’t getting vaccines and they want them, that’s an important thing [for politicians] to know,” she said.

“We have a lot of science and evidence that shows vaccination saves lives. The important message is that most people, most families, even after doing their own research, decide to get their children vaccinated.”