A COVID-19 outbreak hit Jan Keister’s workplace at a law office. Three days ago, she tried to get vaccinated to protect herself and her immunocompromised partner but wasn’t able to get the shot at a pharmacy or from her doctor’s office.
Her regular pharmacy in Roanoke said she needed a prescription, even though she’s over 65 and qualified under new federal COVID-19 regulations. Staff at her doctor’s office said they didn’t yet have doses for the 2025-26 season. She stopped at an urgent care clinic, where they told her she could get one, but the visit would cost her $80 and she would have to wait at least an hour to see a doctor.
Over the last few days, the requirements for accessing the vaccine have shifted rapidly. On Wednesday, the Virginia Department of Health issued new guidance aimed at resolving the confusion — at least for a while.
The new order allows anyone over 65 years old to get a vaccine without a prescription. Anyone over 18 with at least one condition that increases their risk of severe illness can also get vaccinated at a pharmacy without a prescription. Qualifying conditions include cancer, chronic kidney disease, chronic lung disease such as asthma or COPD, diabetes, heart conditions and smoking, according to the Centers for Disease Control and Prevention.
Information on the Health Department’s website advises patients to check with their insurance provider to confirm whether the COVID vaccine is covered.
Across the region, pharmacies are adjusting to the new guidance. Roanoke-based Carilion Clinic began offering COVID-19 vaccines to qualifying patients without a prescription at its retail pharmacy locations on Wednesday, according to spokesperson Hannah Curtis. Patients may self-attest their condition without providing proof, Curtis said.
Since COVID-19 vaccines became available in late 2020, they have been broadly accessible to anyone who wanted one, often at pharmacies or in doctors’ offices. This availability was possible under the Food and Drug Administration’s emergency use authorization, a mechanism that allows the use of medical products during public health emergencies before they complete the full approval process.
In late August, the FDA revoked this authorization for COVID-19 vaccines for the general public, making administering vaccinations complicated for local providers. Prescriptions were required for everyone, including people over the age of 65 who wanted the vaccination.
The state order temporarily removes the need for a prescription until additional guidance from the CDC is released. On Sept. 18 and 19, the Advisory Committee on Immunization Practices is scheduled to meet to discuss and potentially vote on new recommendations for vaccines that protect against COVID-19, hepatitis B and measles.
ACIP is an expert panel that advises the CDC on immunizations. If ACIP fails to vote on new vaccines or vaccine recommendations next week, insurance coverage could roll back, according to the Commonwealth Fund, a nonpartisan research group. Insurers would not be required to cover the vaccines and could impose cost-sharing. There would likely be a patchwork of coverage, causing further confusion among the public.
In June, Secretary of Health and Human Services Robert F. Kennedy Jr. removed the 17 voting members of the expert panel in order to replace membership. The committee makes recommendations to the director of the CDC, who almost always approves those recommendations.
On Aug. 29, Jim O’Neill was appointed the director of the CDC. He previously had filled the role of deputy secretary to Kennedy.
Kennedy has publicly questioned the efficacy and safety of vaccines. His long-standing skepticism has drawn criticism from public health experts who warn the rhetoric undermines confidence in proven immunization programs.
Confusion about eligibility as COVID cases rise
Confusion and delays in accessing COVID shots have been compounded by the changes made under Kennedy’s administration.
In May, the FDA announced that additional clinical trials would be required to approve annual COVID-19 boosters.
Eligibility was limited to adults over 65 and those with at least one condition that increases the risk of severe illness. Kennedy also announced that COVID-19 vaccines would no longer be recommended for healthy children and pregnant women, reversing earlier recommendations from the CDC. Removing these recommendations could mean that health insurance companies are no longer required to cover the cost of vaccines for this population.
The U.S. has also slowed the production of mRNA vaccines through the August cancellation of biotech contracts. The decision followed a comprehensive review of the mRNA investments made during the pandemic, according to an announcement from the federal Department of Health and Human Services. The cancellation impacted 22 mRNA vaccine development projects.
For Keister, the delays are especially disruptive. She knows that her immune system responds strongly to vaccines. When a COVID or flu shot prompts her cells to produce a harmless viral protein, her immune system reacts forcefully, preparing her body to respond if it encounters the virus later. She typically takes a day or two off work to manage the headaches and chills that follow.
Many people do experience short-term side effects, according to the CDC. These are generally a sign that the immune system is active. People with weaker immune systems often have less robust immune responses to vaccines and may have fewer side effects.
Keister said she makes a point to stay up-to-date on her COVID and flu shots because her partner has serious health problems and could become severely ill if exposed to a respiratory virus.
“It’s very frustrating and I’m very worried because we have an outbreak again here at work. … I mean, literally people are going to have to be hospitalized and could die. It’s very frightening and frustrating,” Keister said.
COVID infections are climbing again in Virginia. During the week ending Aug. 30, the state Health Department reported 4,271 positive tests — nearly matching the February peak of 4,289. The following week, ending Sept. 6, saw 3,954 new cases.
COVID-19 deaths continue as well. Since July 27, 17 people have died in Virginia due to the virus.
About 14% of Virginians received the 2024-25 COVID vaccine. Adults 65 and older had the highest coverage of any age group, according to the Virginia Department of Health.
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Correction 11:20 a.m. Sept. 15: The CDC’s Advisory Committee on Immunization Practices meets this week to discuss and potentially vote on new recommendations for vaccines. The body was misidentified in an earlier version of this story.