At 38 weeks pregnant with her second child, Hannah Robb has no time to waste on red tape. Yet she’s lost hours in her struggle to figure out whether and when she can get a COVID booster. Her doctor said she could—and should, she told me. According to her doctor, she wouldn’t need a prescription; according to her local New York City Walgreens, she would. When Robb finally arrived at her appointment at the pharmacy, prescription in hand, she wasn’t sure whether the shot, which can cost $250 out of pocket, would be covered by insurance; so far, no one has billed her, so she assumes it was. “It’s hard to know what’s right and what’s wrong until you show up to the pharmacy and see what they’ll do,” Robb told me.
Similar scenes are playing out at drugstores across the country. The Trump administration’s recent swerves in COVID-vaccine policy have left many Americans—including pharmacists and physicians—confused about where the shot will be available, who is eligible to receive it, and who will be covered by insurance. Pregnancy raises the stakes of that confusion: Pregnant women face an elevated risk of becoming severely ill from COVID, as do newborns, who cannot be immunized against the coronavirus before they’re six months old. The federal government’s guidance on pregnancy and COVID vaccines is now so tangled that Jennifer Lincoln, a board-certified ob-gyn in Oregon, told me that people have asked her whether they should hide the fact that they’re pregnant to more easily receive a shot.
Previously, the COVID-vaccine approval process went something like this: The FDA reviewed the safety and efficacy of updated versions of the shots, then approved them for certain groups of people. Next, the CDC translated the FDA’s guidance into public-health recommendations, on which individual states based their own immunization policies. Although states ultimately determine who is eligible and whether a prescription is necessary, the Affordable Care Act requires insurers to cover any vaccine the agency recommends. Annual COVID shots have, until now, been recommended by the CDC for all adults, including pregnant women, and have thus been covered by insurance.
The process this year has taken a wildly different trajectory. In May, the FDA announced that it would narrow eligibility for annual COVID vaccines to only adults over 65 and people with certain high-risk conditions, including pregnancy. Days later, Health and Human Services Secretary Robert F. Kennedy Jr. announced that the CDC would no longer recommend COVID vaccines for healthy children or healthy pregnant women, claiming, inaccurately, that no evidence supports the use of the booster in children. The CDC clarified that healthy children could get the vaccine after consulting with their doctor, and last month, the FDA approved three updated COVID vaccines that healthy children can receive (again, after a medical consult). But neither agency has offered any new guidance about pregnancy and COVID vaccination since then. (The Department of Health and Human Services, which oversees both the CDC and the FDA, did not respond to a request for comment.)
The chaos has left pharmacies in a bind. At the beginning of this year, roughly half of states based their policies on the CDC’s recommendations, Brigid Groves, the American Pharmacists Association’s vice president of professional affairs, told me. (Other states, she said, incorporate the guidance of the FDA, the state health department, and other groups that issue vaccine recommendations.) According to Groves, after the CDC changed its recommendations, pharmacists in those states lost the authority to vaccinate pregnant people. Even in states whose policy deviates from the CDC, each pharmacy can set its own boundaries on who can be vaccinated, and individual pharmacists may fear liability for vaccinating pregnant customers, Groves said. Last month, CVS stopped offering COVID vaccines entirely in three states. A CVS spokesperson told me that COVID vaccination has resumed in the three states where it was paused, and that people must attest to their eligibility when scheduling an appointment.
[Read: A massive vaccine experiment]
Doctors are unhappy with the confusion. Last month, the American College of Obstetricians and Gynecologists (ACOG) reaffirmed its stance that women should get a COVID vaccine or booster while pregnant, trying to get pregnant, postpartum, or lactating. “To act like they’re not high-risk just by virtue of being pregnant shows no actual understanding of data and science,” Lincoln said. Pediatricians are concerned too. The COVID vaccine “protects both the mom and the baby” because the mother’s antibodies are passed to the fetus, says James Campbell, a pediatrics professor at the University of Maryland who is also the vice chair of the American Academy of Pediatrics’ committee on infectious diseases. According to the CDC, newborns have a higher COVID-related hospitalization rate than that of any other age group besides people 75 and older. “The younger the child, the more likely that they’re going to be hospitalized,” Campbell told me.
A long-awaited meeting of the Advisory Committee on Immunization Practices—the group that informs the CDC’s recommendations, which Kennedy recently repopulated with several members who are hostile to vaccination—may clarify later this week where pregnant women stand. But in the meantime, states in favor of offering the vaccines are taking matters into their own hands. In recent weeks, 16 states have moved to expand access to COVID vaccines, some by granting state health departments the authority to set vaccine policies or allowing pharmacists to defer to medical organizations such as ACOG rather than the CDC. Massachusetts became the first state to require insurers to pay for all vaccines recommended by the state health department, regardless of CDC guidance. Several West Coast states have allied to develop joint vaccine recommendations; some states in New England appear to be doing the same. Jennifer Kates, a public-health expert at KFF, a nonpartisan health-policy organization, told me she expects more blue states to follow suit.
Policy is far from the only factor that will determine whether Americans—pregnant or otherwise—receive their COVID shots this fall. COVID vaccines have never been particularly popular among pregnant women; since 2023, uptake has hovered below 15 percent. People tend to be more anxious about what they put into their body during pregnancy, especially vaccines, Lincoln said. One 2024 study found that mothers worried that getting a COVID shot while pregnant would endanger their baby; a 2023 KFF poll found that a quarter of American adults thought COVID vaccines had “definitely or probably” been proved to cause infertility. Today, copious evidence shows that vaccination protects both mother and child. But fears about the safety of getting the shot during pregnancy have been stoked by politicians and public figures airing anti-vaccine talking points on the national stage. “I hear an increase in vaccine hesitancy in my clinic every week,” Anne Waldrop, an ob-gyn and a clinical professor focusing on maternal fetal medicine at Stanford, told me. Meanwhile, Kennedy has reportedly asked health officials to compile data linking COVID vaccines to poor pregnancy outcomes—a measure that seems destined to provoke even greater anxiety. (HHS responded to the report by restating its commitment to transparency, and the White House reiterated its support for Kennedy’s leadership.)
[Read: Why RFK Jr.’s anti-vaccine campaign is working]
When health care becomes complicated, the standard response is to ask your doctor for advice. Yet even some providers aren’t offering straight answers. Francesca Cohen, who is 37 weeks pregnant, told me that her obstetrician never recommended that she get a COVID booster. “I live in Austin, Texas. I assume they have a mix of perspectives in their patient base,” she said. When Cohen brought up the vaccine, her provider shared ACOG’s guidance and said that the choice was up to her. Cohen is still deciding.
*Illustration sources: How Wee Choon / Getty; Grace Cary / Getty; Sergey Ryumin / Getty (edited)