On Monday, the Food and Drug Administration approved the latest Covid vaccines, updated to protect against current strains of the coronavirus. The following day, the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices recommended that the vaccines be available for anyone over the age of 6 months.
These are the first Covid vaccines to be released through the commercial market.
The question, though, is how many people eligible for the vaccines under this broad recommendation will actually get vaccinated and whether everybody who wants to follow the recommendation will be able to, given that these are the first Covid vaccines to be released through the commercial market.
Announcing the decision, Dr. Mandy Cohen, the CDC director, posted on X: “We have more tools than ever to prevent the worst outcomes from Covid. Today, @CDCGov recommended an updated Covid vaccine for everyone 6 months + older!”
Every time a public health official says “we have the tools” to fight Covid, I imagine other public health officials sadly whispering to one another, “That doesn’t mean anyone will use them.” In this case, the sentiment was expressed out loud by a professor of pediatrics who sat on the CDC panel. In a story Tuesday on the medical news website STAT, she discussed the universal recommendation. “I think we’ll recommend it,” she said of the new vaccines, “and nobody will get it.”
It’s a legitimate concern.
Only about 20% of adults received the last updated vaccines, which were released in September 2022. The current vaccines will be the first ones to be put out directly through the commercial market, with prices at $120 to $130 per dose. For some, this will be covered by insurance; for those without insurance, vaccine manufacturers have offered to donate doses, and CVS and Walgreens have announced that everybody who’s eligible will be able to receive their supply of the vaccines at no cost. Nevertheless, access and cost will be barriers for many people.
And it’s not just vaccines that are underused or hard to access.
A study published in July by the Journal of the American Medical Association found that only 18% of nursing home residents with Covid, who fall into a recommended group for treatments, received monoclonal antibodies or oral antiviral agents (e.g., nirmatrelvir-ritonavir, known as Paxlovid). Forty-one percent of nursing homes in the study never used any of these treatments, and, sadly but not surprisingly, facilities with more low-income residents or residents who belong to racial or ethnic minority groups were less likely to have used them.
The tools we have against Covid include those to help prevent us from getting ill in the first place. They include masks and rapid tests, which are especially good to use before indoor gatherings at close quarters. But in a recent poll, only about 12% of respondents reported regular mask use in public. Those personal choices are compounded by a systemic change. Insurance companies are no longer required to cover the cost of at-home Covid tests now that the public health emergency has ended, which means the cost of testing has become prohibitive for many people.
So the new vaccines, which are hitting pharmacy shelves this week, arrive on the scene in the context of these kinds of deflating statistics. On the bright side, in a KFF poll this year, 53% of adults said they would be likely to receive an annual Covid vaccination “like a flu shot”; this matches up pretty well with the percentage of people who got flu shots last year, so it may be that for some, periodic Covid vaccinations are beginning to feel comfortable and routine.
Now, the CDC could have recommended that a narrow population of people get vaccinated, such as people over 65 or those who are immunocompromised. Instead, it gave a multifaceted rationale for a broad, universal vaccination recommendation. That rationale includes the high ongoing and projected number of hospitalizations and deaths from Covid, in absolute terms; the fact that healthy children and adults can also experience severe illness; emerging data showing that vaccination may prevent development of post-Covid conditions (i.e., long Covid) in children and adults; the safety profile of the Covid vaccines for all ages and the low likelihood that these new vaccinations would pose additional risks; and the high estimated benefit in terms of averting hospitalizations and deaths from Covid. Because we don’t want to spread illness at school or work, my family and I will be getting an updated vaccine, along with the annual flu vaccine. For these reasons, and because we don’t want to miss school or work or spread illness at school or work, my family and I will be getting an updated vaccine, along with the annual flu vaccine. It may seem like a lifetime ago, but back in 2019-20, the influenza vaccine was believed to have made a “significant difference in reducing negative health outcomes” by averting 100,000 hospitalizations and 7,100 deaths. This winter’s Covid vaccines are projected to prevent as many as 400,000 hospitalizations and 40,000 deaths. We’ve lost a sense of scale and of the value of health and life if we don’t find this level of potential benefit worth it. Oh, yes, we have tools. Whether we make them accessible and use them widely or allow them to collect dust remains to be seen.
Dr. Esther Choo
Esther Choo, M.D. M.P.H., is an emergency medicine physician, health policy researcher and founding member of Equity Quotient, a company that advises organizations on building cultures of equity. She has provided commentary on the pandemic and other health care topics through appearances on MSNBC, CNN, the BBC and Yahoo! Finance and editorials published in The Lancet, the British Medical Journal, The Washington Post, NBC Think and USA Today. 
