By Mike Stobbe and Lauran Neergaard, Associated Press

Health Secretary Robert F. Kennedy Jr.’s new vaccine advisers added confusion Friday to this fall’s COVID-19 vaccinations — declining to recommend them for anyone and leaving the choice up to those who want a shot.

Until now, the vaccinations had been routinely provided to nearly all Americans who wanted them. The Food and Drug Administration (FDA) recently put new restrictions on this year's shots from Pfizer, Moderna and Novavax, reserving them for people over 65 or younger ones who are deemed at higher risk from the virus.

Before the decision from the vaccine advisory committee was issued, Nevada Health Authority (NVHA) Director Stacie Weeks told The Nevada Independent on Thursday afternoon that the authority believes that COVID vaccines can still be covered under Medicaid and the state’s Public Employees’ Benefits Program, regardless of the FDA’s label restrictions. 

“NVHA will be working to ensure coverage through its programs is maintained for all populations, as the COVID-19 vaccine is an FDA-approved vaccine,” Weeks wrote. “At this time, we believe Nevada Medicaid has sufficient authority to continue to cover COVID-19 vaccines.”

Though other states have specified that insurers must honor off-label prescriptions of the COVID-19 vaccine — those not for seniors or high-risk patients — Weeks said that Nevada has no authority to mandate private insurers cover COVID-19 vaccines outside of recent FDA label restrictions. She said this may be something the state needs to reconsider if private insurers in Nevada decide not to cover off-label use.

State officials did not immediately respond after the vote as to how the vaccine advisers' decision could affect coverage in Nevada. 

Despite the recommendation change, the insurance trade group AHIP, formerly known as America’s Health Insurance Plans, said members of the group will continue to cover updated COVID-19 and flu vaccines with no cost-sharing to patients through the end of 2026.

Changes to vaccine recommendations 

In a series of votes, advisers to the Centers for Disease Control and Prevention didn’t specifically recommend vaccination but said people could make individual decisions.

The panel also urged the CDC to adopt stronger language around the supposed risks of vaccination, an idea that received pushback from outside medical groups who said the shots had a proven safety record.

And the divided panel narrowly avoided urging states to require a prescription for the shot.

Dr. Sean O’Leary of the American Academy of Pediatrics called the decision not to recommend vaccination "extraordinarily vague" and said it would have “real-time impacts on American children.”

He said the discussion involved clear efforts to “sow distrust” about vaccines.

“It was a very, very strange meeting,” O’Leary said.

The COVID-19 vaccines are not perfect, but CDC data shows they provide the strongest protection against severe infection and death, even if people still become infected. Likewise, people can get COVID-19 repeatedly as the virus continues to evolve.

Like flu vaccines, COVID-19 shots now are being updated yearly, but only about 44 percent of seniors and 13 percent of children were up to date on the coronavirus vaccinations last year, the CDC said.

“If you make a recommendation that people are simply not going to follow, I don't think that’s wise,” said panelist Dr. Cody Meissner of Dartmouth College.

Another question concerns a very rare side effect mostly in young men — a kind of heart inflammation called myocarditis — that was discovered in the early days of vaccination in 2021. A scientist studying whether people with certain genes are uniquely susceptible to that risk told the panel the Trump administration had canceled his grant before the research could be finished.

The panel took up COVID-19 vaccinations as the virus remains a public health threat. CDC data released in June shows the virus resulted in 32,000 to 51,000 U.S. deaths and more than 250,000 hospitalizations last fall and winter. Most at risk for hospitalization are seniors and young children — especially those who were unvaccinated.

Worried about access, leading medical groups, including the American Academy of Pediatrics, have already issued recommendations that the vaccines be available to anyone age 6 months and older who wants one — including pregnant women — just like in prior years.

Several states have announced policies to try to ensure that access regardless of Friday’s federal vaccine advisory committee decision. The panel opened the second day of its meeting with continued confusion over a question it left hanging Thursday: Whether to end a longstanding CDC recommendation that all newborns be vaccinated at birth against a liver virus, hepatitis B.

The panel had been considering whether to recommend delaying that initial vaccination — something doctors and parents already can choose to do. But amid criticism from independent pediatric and infectious disease specialists who say the vaccine is safe and has helped infant infections drop sharply, the advisers decided Friday to postpone that decision.

On Thursday, the panel recommended a new restriction on another childhood vaccine.

They recommended that for children younger than 4, their first dose of protection against MMR — measles, mumps and rubella — and chickenpox should be in separate shots, not a combination version known as MMRV. Since 2009, the CDC has said it prefers separate shots for initial doses of those vaccines and 85 percent of toddlers already do.

On Friday, the committee also recommended that the government’s Vaccines for Children program — which covers vaccine costs for about half of U.S. kids — align its guidance with that narrower MMRV usage.

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Neergaard reported from Washington. Associated Press writer Laura Ungar in Louisville, Kentucky, contributed to this report.

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The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Department of Science Education and the Robert Wood Johnson Foundation. The AP is solely responsible for all content.