by Edwin Quinabo
New FDA COVID-19 vaccinations, CDC recommendation
On August 27, 2025, the U.S. Food and Drug Administration approved the updated COVID-19 vaccines. These vaccines are now available only to individuals over 65 years old, as well as adults and children with underlying health conditions that put them at higher risk for severe disease. It is the tightest restrictions for who can access the vaccines in the years since COVID-19 vaccines became available.
Drawing controversy is the exclusion of COVID-19 vaccination of pregnant women and healthy children that medical societies are advocating for. Jon Avery Go, MD, Internal Medicine, told the Filipino Chronicle, “Medical societies generally give guidance to the healthcare system and to clinicians in medical decision-making. These [FDA changes] may lead to variations in implementation of insurance coverage, pharmacy availability, and state guidelines may now differ, making access uneven and messaging even more confusing,” Dr. Go said.
Pharmacists and insurance groups indicate that obtaining the COVID-19 vaccine will become more challenging, as it will now require a visit to the doctor instead of the pharmacy. Additionally, insurance coverage for the vaccine remains uncertain across different states.
Insurance coverage of COVID-19 vaccinations
For now, it’s not clear what would happen for people covered by government-funded insurance like Medicare and Medicaid — which is tied to the CDC recommendations. Private insurance providers have suggested they could continue to cover the cost of COVID vaccines for anyone who gets a shot.
Both government-funded insurance and private health insurers are awaiting further guidance from the CDC’s advisory panel which is expected to meet in late September.
Hawaiʻi’s health insurers have announced that they will cover COVID-19 vaccinations for everyone older than six months, despite the new FDA guidance stating that children and healthy adults do not need the shots.
Trump administration officials insist that “100%” of adults in this country can still get the vaccine if they choose, said FDA Commissioner Marty Makary. Health experts say while this is true that doctors can still determine that a non-eligible person can get the vaccine “off label” and can give the person a shot, but the confusion around the new policy and doctors going around the federal guidelines make it more difficult for people to get the prescription.
Specialty Medical Societies’ guidelines at odds with the CDC guidelines
Seiji Yamada, MD, MPH, Professor, University of Hawaii’s John A Burns School of Medicine, explains to the Chronicle, “For most of the careers of practicing physicians, the recommendations of the Advisory Committee on Immunization Practices (ACIP) have been distributed by the CDC and largely rubber-stamped by [special medical societies] organizations such as the American Academy of Pediatrics (AAP), the American College of Obstetrics and Gynecology (ACOG), the American Academy of Family Physicians (AAFP), and the American College of Physicians (ACP). The CDC (under which the ACIP meets) and the FDA are U.S. government agencies under Health and Human Services, for which Robert F. Kennedy Jr. is currently the secretary.”
Dr. Yamada elaborates, “Practitioners have been used to pulling up the ACIP vaccine schedule to guide their vaccination practices. We now face a situation in which the specialty medical societies hold opinions that are at odds with the federal government.”
State health departments and specialty medical societies, including the American Medical Association (AMA) have broken from HHS Secretary Kennedy Jr. to side with their own guidelines.
“RFK Jr.’s changes reflect his long-standing skepticism toward vaccines and distrust of federal health institutions. On the other hand, the AMA, AAP and ACOG see themselves as guardians of evidence-based medicine. They’re maintaining their guidance to protect public trust and ensure children, pregnant women, and immunocompromised people remain protected against COVID-19,” Dr. Go said.
Specialty Medical Societies guidelines
WHO, AMA, AAP and existing standards recommend that people who have never received a COVID-19 vaccine, are age 65 and older, are immunocompromised, live at a long-term care facility, are pregnant, breastfeeding, trying to get pregnant, and/or want to avoid getting Long COVID-19, should get the vaccine.
Dr. Rainier Dennis Bautista, President, Philippine Medical Association of Hawaii (PMAH), told the Chronicle, “Mixed messages are coming from two different approaches. Professional groups like AAP and ACOG are sticking with guidance grounded in robust clinical trials and ongoing public-health data, which continue to support vaccination for keiki and during pregnancy. Recent federal guidance has diverged from that broader evidence-based consensus.”
He elaborates, “I follow the recommendations of the various specialist societies. So, I would recommend the vaccines to 1) Adults 65+ and people 6 months–64 years with risk factors, 2) Pregnant patients and 3) Children, especially ages 6–23 months and kids with chronic conditions.
Dr. Go’s recommendation, “As a primary-care physician I would recommend the new COVID-19 vaccine for everyone aged 65 and older, and anyone with chronic medical conditions that increase risk of severe COVID. I would continue to recommend vaccination in pregnancy. Maternal vaccination reduces the pregnant person’s risk of severe disease and is associated with benefits for the fetus/newborn. For children and healthy adults under 65 without risk factors, I recommend shared decision-making. Children at higher risk with underlying chronic medical conditions should be prioritized for vaccination. For healthy children, the benefits are smaller on a population basis but still not nil. Vaccination is protective, especially for healthcare workers, caregivers, educators or those who want to reduce any risk of Long COVID.”
Is COVID-19 still a health risk?
The challenge is that individuals who are elderly, have underlying medical conditions, or are immunocompromised, remain at significant risk of severe illness and potential death from this virus.
Daily reported deaths in the United States have significantly decreased from the alarming highs of over 5,000 deaths per day in 2021 to approximately 280 deaths per day by the end of February this year.
Through the week ending August 16, 9.9% of the 32,998 Americans tested were positive for COVID-19, according to the CDC’s latest data. This was an increase of 1.4 percentage points from the previous week. During the same period, 0.4% of cases resulted in death, the same as the week prior, and 1.2% resulted in an emergency room visit, an increase of 0.2 percentage points.
“Although the number of cases has dropped from the pandemic peak, people are still getting sick enough to be hospitalized. They are also at risk of developing Long COVID and dying. If surveillance, vaccination and gene sequence tracking stops, new variants can evolve and may create higher virulence, or previous immunity may not work,” stated Dr. Go.
Dr. Bautista believes COVID-19 remains a public health issue “because it still hospitalizes and kills Americans every week. We also carry a continuing burden of Long COVID, and viral evolution hasn’t stopped. Sensible layers like vaccination for those at risk, timely testing/treatment, and seasonal precautions remain worth it to keep schools, clinics, and workplaces functioning.”
Who is at risk most? Elderly, Young Children, the Pregnant
Dr. Yamada said COVID has been, and will continue to be, most deadly for the elderly. The very young are at risk, too. He references Aug 19th guidance, the American Academy of Pediatrics, that states, “The rate of COVID-19 hospitalization for children under 2 years is the highest among pediatric age groups and for children ages 6-23 months, it is comparable to people ages 50-64 years.”
“The American Academy of Pediatrics remains focused on increasing access to vaccines for all children, in all communities,” said Susan J. Kressly, MD, president of the AAP. She emphasized that as we approach the respiratory virus season, any barriers to COVID-19 vaccination pose a significant risk to children and their families. Respiratory infections are particularly dangerous for infants and toddlers, whose airways and lungs are still developing.
The AAP recommends the vaccine for all kids from ages 6 to 23 months. “Beyond age 2, we recommend annual shots for children and teens with health conditions that make COVID-19 especially risky,” the statement says, also advising parents to talk to their pediatrician to make the best choice for their kids.
Dr. Yamada said the pregnant are also at risk. The Aug 22nd guidance, the American College of Obstetrics and Gynecology recommends a COVID booster before, during, or after pregnancy while breastfeeding. “They note that pregnant women have historically been at an increased risk of severe disease, adverse pregnancy outcomes, and maternal death from COVID-19 infections,” he said.
Rebecca Fuller, Waimanalo, Hawaii, said the CDC’s new guidelines that remove children and pregnant women from getting the COVID 19 vaccines is alarming. “Science is evolving and so are diseases and viruses. We don’t know in the future if new strains of COVID 19 will emerge and is more harmful to us especially the vulnerable.”
COVID-19 shot trends
COVID vaccine uptake has been low, with just 23% of adults and 13% of children reported getting an updated COVID vaccine last season. About 49% of adults 75 years and older had received the latest COVID-19 vaccine as of December 2024, the CDC reported.
New COVID-19 Variants
NB.1.8.1 remained the most common variant, accounting for 43% of cases, followed by LP.8.1 at 31% of cases and XFG at 14%. New sublineages LP.8.1 and XFG have also been reported. In general, updated vaccines now target the antigenic features of currently circulating lineages, according to the CDC.
“Think of them as cousins in the Omicron family. They spread easily, but there’s no solid evidence they’re more severe than earlier waves. The updated 2025–26 vaccines were tuned to the JN.1/LP.8.1 lineage and are expected to keep doing the most important job: reducing severe illness. Antivirals like Paxlovid still work. In recent U.S. snapshots, NB.1.8.1 has led, with LP.8.1 and XFG also circulating,” Dr. Bautista said.
Symptoms of current COVID-19 strains
Dr. Yamada said for most young, healthy people the symptoms of a new COVID infection range from no symptoms at all, to a mild upper respiratory infection, to a rather severe flu-like illness.
The CDC states that while some people report symptoms like hoarseness or razor blade throat being more common with some variants today, there is no evidence of certain symptoms being unique to different strains.
General symptoms of COVID-19 include fever of chills, cough, shortness of breath or difficulty breathing, sore throat, congestion or a runny nose, new loss of taste of smell, fatigue, muscle or body aches, headache, nausea or vomiting. CDC advises seeking medical care if you experience any of the following symptoms:
*Trouble breathing.
*Persistent pain or pressure in the chest.
*New confusion.
*Inability to wake or stay awake.
*Depending on skin tone, lips, nail beds and skin may appear pale, gray, or blue.
Politicization of the CDC
Kennedy Jr.’s vaccine policy has sparked a backlash from doctors and public health experts. He is a long-time proponent of the position that vaccines cause autism, which has been debunked by the scientific community.
Multiple major medical groups filed a lawsuit challenging the vaccination guideline before the change was made official. The American Academy of Pediatrics, the American College of Physicians, the Infectious Diseases Society of America, the Society for Maternal-Fetal Medicine, and several other medical organizations filed a suit on July 7.
The plaintiffs claim “pregnant women, their unborn children, and, in fact, all children remain at grave and immediate risk of contracting a preventable disease” if left unvaccinated. The suit also argues the directive “is contrary to the wealth of data and peer-reviewed studies that demonstrate the safety and efficacy of Covid vaccines for children and pregnant women.”
Critics point out that HHS Secretary Kennedy is not a physician. He was largely appointed to that position because of his anti-vax advocacy that’s popular among MAGA. Other areas of scrutiny in Kennedy’s leadership include his defunding mRNA vaccine development, his cuts to the Centers for Disease Control and Prevention, in charge of public health, by 15% of its staff, the National Institutes of Health, the largest funder of biomedical research in the world, 16%, and the Food and Drug Administration by 21%. Regulators, scientists, infectious disease experts, researchers – thousands of federal health workers — have lost their jobs and millions in grants cut.
“These cuts are short-sighted and costly. Shrinking CDC, NIH, and FDA, dismissing vaccine advisers, and winding down mRNA programs trade short-term politics for long-term risk. The predictable result is slower responses, higher costs, and avoidable harm. Rebuilding a strong, independent science workforce is non-negotiable for both public health and economic resilience,” Dr. Bautisa said.
On the cuts, Dr. Go said, “The CDC, NIH and FDA job cuts mean cutting core public health, regulatory, and research capacity. These agencies are responsible for cancer-related research, disease monitoring and prevention and many more that I feel will set us back years and will not make America healthy as a nation.”
Rhoda Balmori, Honolulu, said, “we need state of the arts science and research to combat illnesses not just for the Americans but the whole world.
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