Advertisements for COVID-19 vaccinations at health departments have been noticeably absent in recent weeks. The shots are available now, but delays at the federal level meant that uninsured and underinsured Virginians were the last to regain access.
The delay stemmed from a two-and-a-half-week pause at the Centers for Disease Control and Prevention, after its director postponed signing off on recommendations made by the agency’s Advisory Committee on Immunization Practices, or ACIP. That bottleneck temporarily halted vaccine orders for state health departments, which offer free COVID-19 shots to uninsured, underinsured and Medicaid adults and children.
Now that the dust has settled around COVID-19 vaccination, this is who can get the shot and how: Virginians over the age of 3 can receive a COVID-19 vaccination at a pharmacy, a doctor’s office or a public health clinic without a prescription and without meeting the qualifying conditions listed on the CDC website, which briefly dictated who could get a vaccination.
An emphasis on “shared clinical decision-making” from the advisory committee and CDC does not represent a break from how vaccines are distributed. Rather, it reflects a longstanding practice in which health care professionals discuss the risks and benefits of vaccination with each patient.
Shared decision-making refers to a collaborative process between a patient and a trusted health care provider when the risks and benefits of vaccination are discussed. The provider helps the patient make a decision based on the patient’s specific circumstances. In Virginia, pharmacists may also speak with patients and answer questions to help people make an informed decision about the vaccination.
How the delays unfolded
The ACIP, the CDC’s expert panel on vaccines, originally was scheduled to review and vote on updated COVID-19 guidance in June. That meeting was postponed until mid-September following leadership changes at the CDC, and after Health and Human Services director Robert Kennedy Jr. replaced nearly every member of the committee.
When the committee finally met on Sept. 19, it voted to recommend COVID-19 vaccines for everyone 6 months and older, using a “shared clinical decision-making” approach.
Typically, the CDC director signs off on ACIP’s recommendations immediately. This year, approval took more than two weeks. Without it, Virginia couldn’t order vaccines through federal programs for uninsured and Medicaid populations.
The Virginia Department of Health procures vaccines through two channels: a federal contract for populations that are uninsured, underinsured or on Medicaid, and a separate non-federal contract for insured patients. While insured Virginians could still get vaccinated through pharmacies and hospitals, as long as they met certain criteria, those who rely on local health departments for free shots had to wait.
Vaccine ordering resumed Oct. 6 after the CDC director approved the recommendations, according to a VDH spokesperson.
A debate about patient-doctor discussions
Members of the advisory committee put an emphasis on “shared clinical decision-making” when it comes to this year’s COVID-19 vaccine. The meeting saw spirited debate about how vaccination guidance is communicated.
“Informed consent is back,” said CDC Director Jim O’Neill in an Oct. 6 press release. “CDC’s 2022 blanket recommendation for perpetual COVID-19 boosters deterred health care providers from talking about the risks and benefits of vaccination for the individual patient or parent. That changes today.”
O’Neill is also the deputy secretary of Health and Human Services.
Several Virginia physicians and public health experts say that phrasing doesn’t represent a meaningful shift from past practice.
Dr. Costi Sifri, director of epidemiology at the University of Virginia Health, said some comments made by new advisory committee members reflected “misinformation” about how health care providers interact with their patients. Several committee members suggested that conversations between doctors and patients about the COVID-19 vaccine weren’t occurring, he said.
“I think that was done without evidence. It was done with hearsay and a lot of anecdotal reflections by members of the committee. I think that was a very unfortunate display,” he said.
Patients receive vaccinations from trusted health care professionals across specialities, Sifri said. Primary care doctors, oncologists, infectious disease doctors, transplant physicians and obstetricians all routinely offer individualized guidance for the patients in their care.
“They are all well-versed on risks and benefits of vaccinations, all vaccine-preventable diseases in those patient populations as part of their everyday practice,” Sifri said.
What shared and individual decision-making really mean
Since the advisory committee vote, the CDC’s immunization recommendations for COVID-19 use the term “individual decision-making,” which aligns closely with the concept of “shared clinical decision-making.”
This refers to the discussion between health care professionals and patients during which the provider guides the patient in making a choice that fits their individual health needs and circumstances. In Virginia, pharmacists also play a role in this process by answering questions and helping people make informed decisions about getting vaccinated.
Individual decision-making means that patients will ultimately make the final decision for themselves. This has always been the case in the U.S., said Lisa Lee, senior associate vice president for research and innovation and leader of the Division of Scholarly Integrity and Research Compliance at Virginia Tech.
Vaccines are not federally required for the general population. Adults have the legal right to decline vaccination, though there are some contexts where vaccination can be required as a condition of participation.
With COVID, some private businesses and employers require guests and staff to get vaccinated or take other precautions, such as wearing a mask, to decrease the spread of the virus.
All federal vaccine mandates were lifted when the national public health emergency ended in May 2023, though many private businesses began dropping their vaccination requirements before that.
“With COVID, when it first started, there was a default prompt to get vaccinated in order to return to school or in order to go to a workplace or shop at a particular place. We had these rules that people had to be vaccinated but those have since gone away,” Lee said.
Children attending public schools must have certain vaccinations, but parents in Virginia can request medical, religious or philosophical exemptions.
Some employers in health care settings may require certain vaccines to protect against respiratory viruses, but employees may seek medical or religious exemptions.
Some people left out of the list of qualifying conditions
The list of qualifying conditions that increase an individual’s risk of severe COVID — which for a time was used to determine which Virginia adults could get the shot — still reflects the Food and Drug Administration’s eligibility criteria for this year’s vaccine. However, a standing order from the Virginia Department of Health ensures broader access to the vaccine across the state.
That standing order is still in place.
The CDC’s list of qualifying conditions encompasses a wide range of Americans, Sifri said. It includes things like being immunocompromised and living a sedentary lifestyle as conditions that could put someone at risk of developing severe COVID symptoms.
Even so, that guidance misses some groups. Teams at UVa Health heard from healthy individuals who wanted to get the shot to protect vulnerable family members. Those people didn’t fit neatly into the CDC’s list, which is why the advisory committee updated guidance to emphasize shared decision-making, Sifri said.
It’s important to note that nothing has changed in the data, evidence or biology to indicate that there should be a change in who should get the vaccine, Lee said.
Implications for public health
For the first time in modern history, several major professional organizations, including the American Academy of Family Physicians, the American College of Obstetricians and Gynecologists and the American Academy of Pediatrics, have all issued vaccination guidance that diverges from federal policy, even though the CDC shifted away from tightly restricting eligibility based on qualifying conditions.
For example, the American Academy of Pediatrics urges that children ages 6 months to 23 months be vaccinated, diverging from federal guidance that says COVID shots in children must follow shared decision-making with a pediatrician. The AAP more broadly recommends vaccinations for children.
Prior to the advisory committee vote, the AAP published broader recommendations, urging that all children and adults, including those who are pregnant, receive the COVID-19 vaccine — pushing back on the more limited eligibility set by the FDA.
Some states have also banded together to issue their own science-based guidance. The West Coast Health Alliance — formed by California, Oregon, Washington and Hawaii — has coordinated public health policies and vaccination recommendations in response to shifting actions at the federal level.
Because CDC guidance has moved to more flexible language such as “shared decision-making,” there is a wider gray area in how eligibility and recommendations are interpreted. Some of these groups aim to make more assertive recommendations.
This divergence, however, means patients and health care professionals are navigating multiple sources of guidance. Lee said this fragmentation can make it harder for patients to tell whether advice is rooted in science or politics.
“It used to be that we could trust the government to help us make these decisions,” Lee said. “Now it’s being pushed to us and that is going to be really challenging because this is highly technical stuff.”
Vaccination trends in Virginia
Last year, about 14% of Virginians received a COVID-19 vaccination. Data collection for the 2025-26 respiratory virus season started in late August, but so far, 277,121 Virginians have received the shot. In just over a month, about 10% of residents over the age of 65 have been vaccinated.
Anyone over age 3 in Virginia can now receive the vaccine, and Virginia’s Medicaid insurers are covering it. For kids under 3, parents must see a pediatrician, who will then administer the vaccine or write a prescription, Lee said.
Most physicians and other health professionals continue to recommend the vaccine, Lee said, unless a patient has a specific medical reason not to get it, such as a history of allergic reaction.
“Vaccination does two things,” Lee said. “It protects individuals, and it protects the community from getting sick.”
While the severity of COVID infections has decreased for many, some healthy people can still experience serious illness. Sometimes, the ripple effects can be significant.
“When you think about what that means for people, they might not be able to go to their job and if they don’t have sick leave, they might not get paid. And that means that if they’re out for a week or two that they can’t pay their rent,” Lee said. “Of something just so little like, you happen to breathe in a virus and now you’re out, you know, two weeks’ worth of pay.”
Public health has always balanced the tension between individual freedom and collective responsibility, Lee said.
The benefits of vaccination remain clear, according to Sifiri and Lee: preventing serious illness and protecting vulnerable populations.