After two days of high-profile firings and forced resignations at the CDC, nationwide pharmacy chain CVS said it would be unable to offer this season’s newly approved COVID-19 vaccine to any patients—even if they meet the FDA’s more stringent requirements for immunization—in 16 states and the District of Columbia where pharmacists are not permitted to administer vaccines that are not recommended by the Advisory Committee on Immunization Practices (ACIP), according to Amy B. Thibault, a spokesperson for CVS.
“We expect to receive the updated 2025-2026 COVID-19 vaccines in the coming days,” Ms. Thibault told Infectious Disease Special Edition. “We’ll administer FDA-authorized COVID-19 vaccines in states where legally permitted at CVS Pharmacy and/or MinuteClinic to meet our patients’ needs.”
Based on the current regulatory environment, which could change, Ms. Thibault said, CVS Pharmacy is offering FDA-authorized COVID-19 vaccinations in Alaska, Alabama, Arkansas, California, Connecticut, Delaware, Hawaii, Iowa, Idaho, Illinois, Indiana, Kansas, Maryland, Michigan, Minnesota, Missouri, Mississippi, Montana, Nebraska, North Dakota, New Jersey, Ohio, Oklahoma, Oregon, Rhode island, South Carolina, South Dakota, Oklahoma, Oregon, Tennessee, Texas, Washington and Wyoming.
“Importantly, in all but three (Massachusetts, Nevada and New Mexico) of the other 16 states, our pharmacies can administer a COVID-19 vaccination, depending on the patient's age, with an authorized prescriber’s prescription,” she said in an email.
“Legally, it makes sense,” said Paul Offit, MD, the director of the Vaccine Education Center at the Children’s Hospital of Philadelphia. “They are following the law, which is that they give vaccines based on ACIP recommendations, and they don’t have an ACIP recommendation for this year’s newly approved COVID-19 vaccine. From the point of view of the pharmacies, the law would have to be changed to enable them to legally give vaccines according to recommendations from the AAP [American Academy of Pediatrics] or ACOG [American College of Obstetricians and Gynecologists], for example.”
Dr. Offit also noted that the new head of ACIP, Martin Kulldorff, PhD, has expressed strong views against COVID-19 vaccines. “He has pretty much said that he doesn’t think we should give these vaccines at all anymore. So therefore, we have no idea what is about to happen because everything that used to be true, which is that policy would be made based on good scientific data, is not true anymore.”
The move by CVS, especially if other pharmacies follow suit, could dramatically restrict access to the vaccine at the crucial early weeks of respiratory virus season in those states, which include Arizona, Colorado, Florida, Georgia, Kentucky, Louisiana, Maine, Massachusetts, Nevada, New Mexico, New York, North Carolina, Pennsylvania, Utah, Virginia and West Virginia, along with Washington, D.C. Between 2022 and 2023, more than two-thirds of COVID-19 vaccine doses were administered by pharmacists (approximately 40.5 million out of 59.8 million), a CDC report found (MMWR Morb Mortal Wkly Rep 2024;73[13]:286-290).
“Most adults get their vaccines from pharmacists,” Dr. Offit said. “The first COVID vaccines became available in December 2020, and by July 2021, we had vaccinated 70% of the U.S. population in a country that doesn’t really have an infrastructure for mass vaccinating adults. Pharmacies and pharmacists are the reason we could do that, but now they’re understandably backing away for legal reasons.”
The newly reconstituted ACIP panel is not scheduled to meet until Sept. 18-19, 2025, and even that meeting is uncertain: On Aug. 28, Sen. Bill Cassidy, MD (R-La.), the chair of the Senate Health, Education, Labor and Pensions (HELP) Committee, called for that meeting to be indefinitely postponed “until significant oversight has been conducted,” noting that “any recommendations made should be rejected as lacking legitimacy given the seriousness of the allegations and the current turmoil in CDC leadership.”
In June, Health and Human Services Secretary Robert F. Kennedy Jr. fired all 17 members of ACIP and replaced them with a new eight-member panel, including several who have openly expressed anti-vaccine sentiments and/or been aligned with anti-vaccination efforts. One resigned before the first meeting, leaving seven members.
“We at SHEA [Society for Healthcare Epidemiology of America] and all of my colleagues in academic medicine and public health are very distraught at the changes in ACIP,” said David Weber, MD, MPH, the president of SHEA. “We believe guidelines should be evidence-based and developed by experts, which the previous panel were. And in addition to removing the panel members, there were also a number of liaison groups that contributed their expertise to ACIP, although they were not voting members. That included SHEA, the American College of Obstetrics and Gynecology, the American Academy of Pediatrics, and many other groups. All of those liaisons and their expertise have also been eliminated from the working groups, as far as I know.”
The CDC has been seriously damaged over the past several months, Dr. Weber said. “It was the premier public health agency in the world, but now its abilities have been tremendously diminished by large-scale cuts in personnel and in financial support. These cuts are going severely erode its ability to support public health in every state.”
Many questions remain about how people will be able to access vaccines in the upcoming cold and flu season, warned experts in a media briefing on Aug. 28 hosted by the American Public Health Association (APHA) and Infectious Diseases Society of America (IDSA). “The cost for vaccines is already baked into the rates for this current calendar year, so there’s probably no reason for insurance companies to not cover the COVID vaccine for financial reasons,” said IDSA Vice President Wendy Armstrong, MD, FIDSA. “But the confusion will be at the point of service. For some pharmacists and nurse practitioners, if it’s not on the schedule, by law they’re not allowed to give it. So that might be a barrier. And then there are some physicians who for a variety of reasons don’t keep vaccines in their office; they’ll write a prescription and send you to the pharmacist for them to administer it. But can they still do that? This means that every board of pharmacy, every board of medicine in this country is probably going to have to bring this up as an agenda item to figure out how to ensure access to vaccines. So we may have 50 different state solutions to this.”
“We don’t know how it’s going to play out,” agreed Philip Huang, MD, MPH, the director of Dallas County Health and Human Services. “We have governmental supplies of vaccines for uninsured and underinsured children, an adult safety net program, and we also try to maintain some private stock to cover others in need. But we don’t know if they will tell us that we can’t give those vaccines now.”
Physicians could also face liability, Dr. Armstrong added. “Two days ago, Secretary Kennedy warned physicians that they could lose their medical malpractice protections if they don’t follow official federal guidance on vaccines, after several medical associations indicated that they would not follow the new recommendations.”
Michael Osterholm, PhD, MPH, the Regents Professor, McKnight Presidential Endowed Chair in Public Health, and the director of the Center for Infectious Disease Research and Policy at the University of Minnesota, in Minneapolis, told Infectious Disease Special Edition: “The important thing is not just having vaccines; it’s vaccination. If we are not able to get vaccines into the people’s arms, we have a problem. We are watching vaccines become weapons, rather than what they have been and should be, which is tools for public health.”
Acting CDC Director Named
Late in the evening on Aug. 28, the Associated Press and the Washington Post reported that Jim O’Neill, the deputy secretary of HHS, had been named as acting director of the CDC. Mr. O’Neill, a former speechwriter for HHS in the George W. Bush administration, most recently worked for billionaire tech investor and PayPal co-founder Peter Thiel. He has no known training in medicine, scientific research or public health, making him the first CDC director in history not to have a medical degree, a PhD or both.
“There’s a lot of trouble at CDC and it’s going to require getting rid of some people over the long term in order for us to change the institutional culture and bring back pride and self-esteem and make that agency the stellar agency that it’s always been,” Mr. Kennedy said in a White House press conference on Aug. 28. “I’m very confident in the political staff that we have down there now, that they’re going to be able to accomplish that and ensure the confident functionality of that agency.”
Mr. Kennedy also inaccurately claimed that the CDC had listed abortion as one of the top medical accomplishments of the 20th century. “They said abortion is the one of the greatest medical accomplishments because it keeps small families,” he said. “Go to the website, look at it. Fluoridation—giving kids a toxin—and vaccines.”
The CDC’s actual list of “Ten Great Public Health Achievements — United States, 1900-1999” is (MMWR Morb Mortal Wkly Rep 1999;48[12]:241-243):
- Vaccination
- Motor vehicle safety
- Safer workplaces
- Control of infectious diseases
- Decline in deaths from coronary heart disease and stroke
- Safer and healthier foods
- Healthier mothers and babies
- Family planning
- Fluoridation of drinking water
- Recognition of tobacco use as a health hazard
—Marie Rosenthal, MS, contributed to this story.
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