The threat of Covid infections has not gone away, but the vaccines that help protect against them will be harder to come by this season.
Under President Trump and Health Secretary Robert F. Kennedy Jr., federal health officials have limited who qualifies for Covid shots. On Wednesday, the Food and Drug Administration approved updated versions only for people who are 65 or older and people who have a medical condition that puts them at higher risk.
The F.D.A. decision creates a fractured and confusing landscape. Healthy adults under 65 may have to jump through hoops to get a shot, if they are able to get one at all. The same is true for healthy children, the youngest of whom are at high risk of Covid complications simply by virtue of their age.
Here is where things stand, and what you can do.
When will the vaccines be available?
Representatives for Moderna and Pfizer said they would ship their updated vaccines almost immediately upon receiving F.D.A. approval. Those shots should begin to reach doctor’s offices and pharmacies after a few days.
Sanofi, which markets the Novavax shot, expects to make its vaccine available in “early fall,” a spokesman said.
Am I eligible for a vaccine?
It depends on your age and health. That’s a major change: Covid vaccines were previously approved for all Americans 6 months and older, but the F.D.A. is now limiting eligibility, a move opposed by many medical experts.
You’re eligible if you are at least 65 or if you have at least one medical condition that puts you “at high risk for severe outcomes from Covid-19.”
The F.D.A. did not specify in its approval which conditions count. However, when two of its leaders indicated in May that the agency was likely to limit eligibility, they cited a long list maintained by the Centers for Disease Control and Prevention. That list includes asthma, cancer, obesity and being immunocompromised, as well as less obvious things like physical inactivity.
F.D.A. officials have estimated that roughly 30 to 60 percent of Americans have at least one such condition.
People under 65 with no underlying conditions aren’t eligible under the F.D.A. approval, even if they live with someone at high risk of severe illness.
What if I’m not eligible but want a vaccine?
Your best chance of getting one is at a doctor’s office, not a pharmacy.
Mr. Kennedy said in a social media post Wednesday that the “vaccines are available for all patients who choose them after consulting with their doctors.”
It’s legal and common for doctors to prescribe medications off label, meaning for uses the F.D.A. hasn’t approved. But there’s no guarantee your doctor will give you a vaccine. Legal and medical experts said they expected some doctors to fear liability if they give shots outside F.D.A. parameters, even if that fear isn’t legally warranted. And even if they agree, your insurance might not cover the shot.
In past years, most people have gotten their shots at pharmacies, said Katelyn Jetelina, an epidemiologist who writes the newsletter Your Local Epidemiologist. But doing that will be more difficult now, if it’s possible at all, for those who don’t meet the F.D.A. criteria — especially if the C.D.C. follows the F.D.A.’s lead and limits the groups for whom it recommends Covid vaccines.
It’s illegal in some states for pharmacists to administer vaccines off label or in the absence of a C.D.C. recommendation. And even where it’s legal, they may be uneasy about doing so.
“I’m just really struggling to think of many places where you would be able to just walk into a pharmacy and find a pharmacist that, one, had the authority and, two, was willing to give you that vaccine if it wasn’t on label,” said Richard Hughes IV, a vaccine lawyer who teaches at George Washington University Law School and worked for Moderna.
Will pharmacies require proof that I’m eligible?
We don’t know yet.
Richard Dang, an associate professor of clinical pharmacy at the University of Southern California, predicted that most pharmacies would simply require patients to complete a form attesting that they meet the F.D.A. criteria.
But some other experts said they expected pharmacists to do more rigorous vetting, such as requiring a doctor’s note or examining prescription records.
“If they feel that their license is at any risk, they’re not going to vaccinate,” said Spreeha Choudhury, a lawyer and former pharmacist.
Representatives for CVS and Walgreens, two of the nation’s largest pharmacy chains, did not immediately respond when asked what policies they would set.
Are Covid shots still free?
For people who meet the new criteria and have insurance, yes. That would change only if the C.D.C.’s vaccine advisory panel broke with the F.D.A. and stopped recommending the shots even for older and high-risk people, said Dorit Reiss, a professor at U.C. Law San Francisco. (Almost all insurers must fully cover the panel’s recommended vaccines.)
For people who get off-label vaccinations, the picture is murkier. For now, the C.D.C. panel still recommends the shots for a wider population, so coverage is required, Professor Reiss said.
But the panel — which Mr. Kennedy purged in June and filled with handpicked members, several of whom have anti-vaccine backgrounds — could change that recommendation at its next meeting.
It would then be up to individual insurers to decide whether to maintain coverage.
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, you should wait three months after a Covid infection before getting a vaccine.
It’s a good idea to get your flu shot at the same time, and your R.S.V. 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, Dr. Ranney said.
Organizations like the American College of Obstetricians and Gynecologists recommend it because of evidence that pregnancy increases the risk of severe illness, that Covid can harm fetuses, and that vaccines given during pregnancy can protect infants.
But access may be complicated by contradictory federal policies: Pregnancy is on the C.D.C.’s list of high-risk conditions, but the agency has stopped recommending Covid vaccines during pregnancy.
As with many other groups, it ultimately may depend on the discretion of individual doctors.
Can children be vaccinated?
It depends on their age and health, and which vaccine brands are available near you.
The F.D.A. has 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.
Children without high-risk conditions would have to be given the vaccine off label. Your pediatrician can legally do this, but there is no guarantee that they will.
The F.D.A.’s decision to restrict approval to children with underlying conditions has 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 recently broke with federal health officials to recommend Covid vaccination for all children 6 months to 2 years old.
How long does the Covid vaccine last?
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 flulike symptoms. These symptoms should clear up in a day or two, and you can take over-the-counter medications like acetaminophen.
Serious side effects are rare. A fraction of a percent of patients experience myocarditis, or heart inflammation. But the risk of developing myocarditis from a vaccine is lower than the risk of developing it from a Covid infection, according to an analysis of nearly two dozen studies.
Christina Jewett contributed reporting.
Maggie Astor covers the intersection of health and politics for The Times.
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