There’s good news about COVID-19. It is no longer among the top 10 causes of death in the United States. But it’s still in the top 15. COVID was the primary cause of 31,000 American deaths in 2024 and contributed to about 14,000 more. Positive COVID test rates and hospitalizations were very low earlier this year but increased, as expected, with the late-summer surge, when U.S. deaths rose above 300 per week in late August and early September. Severe disease and deaths were lower than in previous surges thanks to immunity from vaccinations and previous infections, but wastewater testing showed moderate or high virus levels in most areas across the country.

COVID is still here and still dangerous. We ignore that at our own — and our loved ones’ — peril.

With COVID-19 now endemic (always present), it was reasonable to expect updated vaccines at least annually as we have had for years for influenza. But new vaccines arrived in September without updated guidance, causing widespread confusion, anxiety and frustration.

In Pennsylvania, we CAN get free COVID vaccinations now, as in past years.

But you should know how we got here.

On August 5 Health and Human Services Secretary Robert F. Kennedy, Jr. announced the U.S. was cutting $500 million of funding for mRNA vaccine research, suspending development of a bird flu vaccine, delaying potential applications with cancer and rare diseases, and likely ceding future healthcare leadership to entities outside the U.S.

Kennedy, who is neither a doctor nor a scientist, is a long-standing critic of vaccines, especially those made with mRNA technology. He doesn’t seem to understand how such vaccines work, or even what causes diseases. He disregards the hundreds of studies that show the COVID vaccines are effective and safe, instead cherry-picking and/or misinterpreting studies that seem to support his views.

A study in JAMA Health Forum (July 25) found that COVID vaccines prevented over 2.5 million deaths and saved 15 million years of life in 2020-2024. Yet Mr. Kennedy claims the vaccines not only “fail to protect effectively” but are more deadly than the virus!

Coming amidst the summer COVID surge and the imminent release of an updated vaccine formulated for more current variants, the announcement raised questions about the availability of vaccines for the fall.

Approving new vaccines has long been a straightforward two-step process. The Food and Drug Administration (FDA) approves the vaccine as safe and effective, authorizing its use. Then the Centers for Disease Control and Prevention (CDC), through its expert Advisory Committee on Immunization Practices (ACIP), recommends who should get vaccinated.

Federal law requires most insurance providers to cover annual vaccinations, as has been the case with flu shots for years and for COVID vaccines since 2020. Also, many states require pharmacies to follow CDC recommendations in order to administer vaccines to walk-in customers on demand.

But Secretary Kennedy had already announced in May that COVID vaccination would no longer be recommended for pregnant women and healthy children. On August 27 the FDA approved the COVID booster specifically for people age 65 and older and for people from 6 months to 65 years old who have an underlying condition putting them at risk of severe disease if they get COVID-19. And the ACIP was not scheduled to meet for another three weeks.

Chaos erupted. Boosters were available but many pharmacies refused to administer them. Some states were set to require doctors’ prescriptions for the shots. Physicians publicly challenged the new restrictions. The American Academy of Pediatrics and other medical groups, whose guidelines have generally agreed with the CDC, began issuing their own recommendations based on the best available research.

ACIP, its independent experts replaced by Kennedy with less qualified but like-minded people, held a contentious and confusing meeting on September 19 and recommended, contrary to the new FDA statement, that everyone 6 months of age or older should get the COVID vaccine with “shared clinical decision making” — discussing the benefits and risks of vaccination with a doctor or pharmacist. People under 65 without underlying conditions will need a prescription because the vaccine is now “off label” for them. Off-label — prescribing a medication for something not specifically approved by the FDA — isn’t necessarily a problem. It’s a legal and common judgment call by a doctor, but some providers may be reluctant, and it adds considerable inconvenience and potential cost to the process.

Some states responded proactively to the FDA/CDC muddle. At Governor Shapiro’s request, the Pennsylvania Pharmacy Board voted in September to let pharmacies follow vaccine guidance from several medical organizations. The Department of Health now recommends that Pennsylvanians follow the most recent recommendations from the American Academy of Pediatrics (AAP), American Academy of Family Physicians (AAFP), and American College of Obstetricians and Gynecologists (ACOG). Insurers have promised to cover vaccination at least through 2026.

After that? The future for vaccines is uncertain at best. Secretary Kennedy seems determined to impose his flawed views of health and disease on the entire country.

Now more than ever we need to be well informed about COVID and other vaccinations. We recommend the state Health Department’s latest guidelines, those of the medical societies mentioned above, and the Vaccine Integrity Project at the University of Minnesota. For up-to-the-minute reporting, subscribe to Your Local Epidemiologist, a newsletter written by public health professionals who explain these complex matters with amazing clarity.

Michael Heyd, a retired medical librarian from Fairfield Township who spent more than forty years searching the literature for professional hospital staff, is a member of Let’s end COVID!, a group of concerned people in Northcentral PA working to overcome the COVID-19 pandemic through education, outreach and mitigation.