A leading pediatrician in Nevada said he’s worried that the Trump administration’s narrowing recommendations on who should get a COVID vaccine could reduce access to the vaccine and put the cost out of reach for many Nevadans.

Dr. JP Vilai, a Las Vegas-based pediatrician and vice president of the Nevada Chapter of the American Academy of Pediatrics, said that fewer pediatricians are carrying the vaccine because of the cost of the drug and expense for storing it, fears that parents will opt not to get the vaccine because of differing guidance and concern that there will be a lack of reimbursement for providers. The out-of-pocket cost for the vaccine could be $200 or more.

“COVID-19 can affect children just as much as it can affect the elderly, and it can [have] severe consequences,” Vilai said in an interview Monday with The Nevada Independent. “The concern that I have is this restriction is going to really limit both our ability to protect children from this disease and also to carry the vaccine that will potentially prevent them from getting it.”

In August, the U.S. Food and Drug Administration (FDA) issued new restrictions on eligibility for the COVID-19 vaccine, moving from recommending it for anyone 6 months and older to only people 65 or older and others at high risk of complications.

The Centers for Disease Control and Prevention (CDC) has also stopped recommending the vaccine for pregnant women and children — conflicting with recommendations from significant medical associations, including the American Academy of Family Physicians, the American College of Obstetricians and Gynecologists and the American Academy of Pediatrics.

CVS and Walgreens had stopped administering the vaccine over concerns that Nevada law — which invokes federal recommendations — would preclude doing so. State guidance issued Friday cleared them to offer the vaccine, but access issues remain and could grow in the coming weeks. 

The restrictions on recommendations for who should receive it have raised questions about the ability for doctors to prescribe the vaccine and whether insurance will cover the cost. 

Officials from the governor’s office, the Nevada Health Authority and other state agencies did not have immediate answers to a list of questions sent Monday about the federal restrictions, insurance coverage and access to vaccines. Officials with Nevada Medicaid did not immediately respond to questions about how the FDA restrictions could affect patients on the program, which relies on federal and state funding.

Senate Majority Leader Nicole Cannizzaro (D-Las Vegas) said Monday she was concerned about the restrictions and how they could affect insurance coverage for the vaccine. She blamed the Trump administration for making it harder to access COVID-19 vaccines by severely limiting eligibility criteria.

“If insurance companies or Medicaid also drop coverage, it will make getting the vaccine even more complicated and a lot of people will just give up,” Cannizzaro wrote in an email responding to questions from The Nevada Independent. “Maybe that's Trump and RFK Jr.'s intent or maybe they're truly just that ignorant, but either way, fewer people who want to protect themselves will have that option.”

The Legislature could address the problem in a special session if Gov. Joe Lombardo authorizes it, Cannizzaro noted, adding that lawmakers are reviewing language to allow state regulators to look to authorities beyond the FDA and the CDC to issue vaccine guidance in Nevada. 

Asked about communications with the governor, Cannizzaro said she received advance notice of the Nevada Board of Pharmacy guidance, but has not had broader conversations about vaccine access.

In the meantime, she said she would support regulatory action to require insurance companies to cover prescriptions for vaccines similar to what states like Massachusetts, New York and New Mexico have done.

In response to concerns that insurance will not cover COVID-19 vaccine prescriptions outside federal restrictions, Massachusetts Gov. Maura Healey, a Democrat, issued a first-in-the-country requirement that insurance cover vaccines recommended by the state’s public health department, even if that’s in opposition to the CDC.

As for the supply of the vaccine itself, Nevada State Board of Pharmacy Executive Secretary J. David Wuest said in a Friday interview that there is a limited amount of the latest COVID-19 vaccine in the market, and it is not yet widely available. Although pharmacies may have ordered the new vaccine, he said it may not have arrived yet, but the supply is expected to grow over time.

Though Vilai is a staunch proponent of the vaccine's effectiveness, he said conflicting guidance from medical associations, the CDC and the federal government can lead to confusion and misinformation, negatively affecting parents' decisions about vaccinating their children. He added that the prescription of the vaccine for those not meeting federal recommendations could be considered an “off-label” use of the vaccine, which may mean insurance will not cover it.

“[As doctors], we can recommend it, but where are they going to get it? And if they're able to get it, how are they going to get it paid for?” Vilai said. “Fortunately, there's still the health department, health districts, and there's some of these retail-based pharmacies that are carrying it, and so they can go there, but I do worry about the ability of [patients] to get this covered by insurance going forward.”

He said that parents and families he’s spoken to have already found it challenging to access the vaccine at pharmacies and health departments. He worries that as time passes, the vaccine may not be covered any longer by the federal Vaccines for Children program, which provides free vaccines to children from low-income households, but bases its coverage primarily on FDA and CDC guidelines.

Nevada already ranks 44th lowest in the nation for immunization, with vaccine rates among adults in Nevada significantly lower than the national average. Child immunization rates have also declined since the rollout of the COVID-19 vaccines, which Nevada health officials have warned in the past stems in part from a lack of “vaccine confidence.”

Vilai said that caregivers and parents have a right to be concerned about what goes into their children’s bodies, but it has to be based on sound scientific evidence. He noted that the science surrounding vaccines is sound, and they help protect children, their families and the community at large.

Officials with the Southern Nevada Health District and Northern Nevada Public Health told The Nevada Independent they are not offering the COVID-19 vaccine that was approved last year, but plan to provide the updated COVID-19 vaccine when it becomes available, likely in late September or early October.

When the federal Advisory Committee on Immunization Practices meets Sept. 18 to decide on a list of recommended vaccines, officials from both districts acknowledge that insurance coverage for the vaccine may be adjusted. Under Health Secretary Robert F. Kennedy Jr., 17 members of the committee were fired; some of the newly appointed members are vaccine skeptics.

Vilai said that there are dangers of severe illness following exposure to the COVID-19 virus without being vaccinated. Although initially doctors saw few children affected by the virus, Vilai noted that the virus has since mutated to the point where it affects all populations. Getting vaccinated also protects others who may not be able to be vaccinated or are immunocompromised, he said.

“As pediatricians, we try to do what’s best for our patients, to do what’s best for the children … We try to balance safety with efficacy based on guidelines, based on evidence,” he said. “I think many, many pediatricians are still going to do that. It’s just going to be more difficult as some of these guidelines come out and some of these restrictions come out.”