After federal health officials made abrupt changes to US Covid-19 vaccine recommendations for pregnant women last month, there’s new confusion and uncertainty about who can get the shots — and some reports that patients were turned away when they tried to get vaccinated. Now, 30 health and medical organizations are pushing for continued access and insurance coverage for the vaccines.
“We are deeply concerned about the recently adopted HHS policy to no longer recommend COVID-19 vaccination during pregnancy,” wrote the organizations – including major professional groups for obstetricians, primary care providers, pediatricians, pharmacists and nurses – in an open letter. “It is vital that we ensure that pregnant women continue to have access to this prevention tool so that they can protect themselves and their young infants, a vulnerable group who is not yet eligible for vaccination.”
The letter calls on “payers and insurers to continue making the COVID-19 vaccine available to pregnant people without undue utilization management or cost-sharing requirements,” even though the shots have been removed from the list of vaccines recommended by the US Centers for Disease Control and Prevention.
Pregnant women who have Covid-19 are more likely to require care in the ICU or on a ventilator, or to die, the letter said, and they’re at higher risk of complications such as cesarean birth, preeclampsia or eclampsia, and blood clots. Infants born after a Covid-19 infection also face increased risks.
The letter comes two weeks after US Health and Human Services Secretary Robert F. Kennedy Jr. abruptly announced that the Covid-19 vaccine, which has shown to be safe and effective during pregnancy, would no longer be recommended for pregnant people. Leaders from the US Food and Drug Administration also recently outlined a new framework for the approval process for Covid-19 vaccines that could limit shots to older Americans and people at higher risk of serious Covid-19 infection.
Experts immediately warned that these changes could create new barriers to vaccines for those who want them, including confusion around who is eligible and higher costs for patients if insurance no longer covers them.
The American Pharmacists Association, which signed on to the open letter, said it has already received reports of patients being denied Covid-19 vaccines.
“Because of some complications I had during my first pregnancy, getting the vaccine now and getting that extra boost of immunity would be definitely important for me,” said Haldeman, who got her last shot in the fall of 2024.
At two different pharmacies, she was told it is not recommended for pregnant women to receive the Covid-19 vaccine, based on new guidelines.
She still hasn’t been able to get the shot.
Many doctors still strongly recommend Covid-19 vaccination during pregnancy.
“Despite the change in recommendations from HHS, the science has not changed,” the American College of Obstetricians and Gynecologists said in a statement. “It is very clear that COVID-19 infection during pregnancy can be catastrophic and lead to major disability, and it can cause devastating consequences for families. The COVID-19 vaccine is safe during pregnancy, and vaccination can protect our patients and their infants after birth.”
‘We cannot give this to you’
After an appointment last week, Haldeman agreed with her obstetrician’s advice to get an additional Covid-19 shot during her pregnancy. Her first try was a Walgreens store where she had an appointment to get the vaccine.
“I went through the whole check-in process, and then as soon as the pharmacist saw that I was pregnant, they were like, ‘We cannot give this to you,’ ” she recounted. “ ‘We’re only giving it to immunocompromised people right now.’ ”
She said she asked whether she was considered immunocompromised because she’s pregnant. Haldeman said the pharmacist responded that guidelines have changed, that it’s not recommended and they wouldn’t give it to her.
She then called her primary care provider and obstetrician, but neither had the vaccine in stock. In past years, pharmacies have administered the majority of Covid-19 shots.
Haldeman said her obstetrician suggested trying another pharmacy. She called a Safeway and asked, “I’m 25 weeks pregnant. My provider is recommending that I get this Covid booster. Are you able to give that to me?”
The immediate answer was no.
“I’m under the impression from my provider that I need to get this,” she recalled saying. “Pharmacies are the only people that appear to have it right now. What do I need to do to get this vaccine?”
She said the pharmacist told her, “The guidelines have changed as of last Friday. We can’t give it to you.”
The pharmacist suggested that Haldeman try getting a prescription for the vaccine from her provider so the pharmacy might be able to administer it. Her obstetrician wrote a vaccination prescription and sent it to the Safeway pharmacy, but when Haldeman visited the location at 7 p.m. the same day, she was told the pharmacy hadn’t received the prescription.
The lack of clarity left Haldeman frustrated and uncertain about what to do next.
“I spent half my day on this. … Most people are probably not going to go to those lengths to get the vaccine. The more hoops that you make people jump through, less and less people are just going to get vaccinated,” Haldeman said. “And we know that having Covid during pregnancy does terrible things to your placenta, and certainly reducing that risk is worth it. So it’s very frustrating.”
The American Pharmacists Association said in a news release that the updates to the Covid-19 recommendations “do not appear to be based on the scientific evidence provided over the past few years. … COVID-19 vaccination during pregnancy has been proven safe and effective.”
However, pharmacists “may face consequences if they do not follow the Advisory Committee on Immunization Practices or CDC recommendations,” said Allison Hill, the association’s director of professional affairs.
“HHS’s and CDC’s recent changes to the Covid-19 recommendations create barriers and confusion,” Hill said.
HHS’s unusual updates to the Covid-19 vaccine schedules were followed this week by a sweeping change to the CDC’s Advisory Committee on Immunization Practices, the independent experts who typically guide the agency on its vaccine recommendations. Kennedy bypassed ACIP in making the Covid-19 changes and then said this week that he had dismissed the entire 17-member panel. On Wednesday, Kennedy announced eight new members to ACIP.
The removal of the vaccine advisers sparked a swift backlash from health care providers and professional organizations.
Dr. Tina Tan, president of the Infectious Diseases Society of America, another organization that signed the open letter, said that undermining the integrity of ACIP is “completely unfounded” and has “a significant negative impact on Americans of all ages.”
The pharmacists association said Tuesday, “It is highly concerning that removing 17 scientists overnight eliminates the historical knowledge, scientific training, and clinical expertise required to equip pharmacists and the public to make appropriate choices for health based upon the risk.”
Risks from Covid-19
Since Kennedy announced changes to the Covid-19 vaccine schedule, doctors said they’re worried about their patients and the future of vaccinations.
“We are worried about our patients in the future, who may be less likely to choose vaccination during pregnancy despite the clear and definitive evidence demonstrating its benefit,” Dr. Steven J. Fleischman, president of the American College of Obstetricians and Gynecologists, said in a statement. “We are concerned about access implications and what this recommendation will mean for insurance coverage of the COVID-19 vaccine for those who do choose to get vaccinated during pregnancy. And as ob-gyns, we are very concerned about the potential deterioration of vaccine confidence in the future.”
Studies have shown that infants who are born after a Covid-19 infection during pregnancy are at increased risk of stillbirth, respiratory distress and low birth weight.
“With maternal health being compromised, you have the risk for preterm delivery, babies that are born very small or potentially even fetal loss early on,” Dr. Flor Munoz-Rivas, an associate professor of pediatrics and infectious disease at Baylor College of Medicine, said last week.
Dr. John Lynch, an associate medical director at the Harborview Medical Center and a colleague of Haldeman’s, said Covid-19 vaccination during pregnancy also has benefits for the newborn.
“Vaccinating a mom leads to the protection of the baby when they don’t have their own immune response,” Lynch said.
Since the Covid vaccine is not available to babies younger than 6 months, vaccinating the mother may be the safest way for young children to gain some immunity.
“That first year of life remains the highest period of risk, and this is a vaccine-preventable disease,” Muñoz said. “We can modify the outcomes for these babies through maternal vaccination and through infant vaccination.”