For the first time since the pandemic, there are limits on who can walk into a pharmacy and get a COVID vaccine. 

That’s due to new federal guidance about the shots, which has been ever-evolving since Robert F. Kennedy Jr’s. appointment as secretary of the Department of Health and Human Services. 

As of late September, several Ohio pharmacies were offering the updated vaccine, without a prescription, to people the Food and Drug Administration deemed eligible. That includes people 65 and older and those 64 or younger who have a medical condition that puts them at a higher risk for COVID-19. 

Another federal agency, the Centers for Disease Control and Prevention, has not yet adopted its final recommendation for who should receive the shot this fall. Its advisory committee on vaccines voted in mid-September to recommend that vaccination for COVID-19 for people older than six months be determined by “shared clinical decision-making,” or a discussion between a medical provider and the patient.   

The number of Cuyahoga County residents who get the shot on an annual basis has dropped since it first came out. About 880,000 county residents received a first dose of the COVID shot. Last year, about 180,000 Cuyahoga County residents got an updated vaccine. 

For those who do want the shot – or feel that their health depends on it – the messaging has been stressful and confusing. Uncertainty has also caused frustrations for people who should be qualified under current rules.

“This year I was caught in red tape and finger pointing about coverage, prior authorizations and shifting policies,” said Lindsay Davis, a Lakewood resident in her thirties who got the shot but whose insurance didn’t pay for it. “It felt less like a medical decision and more like a political football. For patients like me, whose lives depend on staying protected, that is absolutely terrifying.”

Others, mostly above the age of 65, said getting the shot was simple and no different from prior years.  

An asthmatic initially rejected by a pharmacy

Erika Dus, a social media influencer and 44-year-old mother of a toddler, walked into a CVS pharmacy in Lakewood to pick up a prescription in early September. She decided to use the opportunity to check whether she could get her COVID shot.

“I did that while my daughter was in school,” Dus said. “Because, you know, having a three-year-old sit there and stay patient while you’re getting a vaccine is not really an option.”

Last year, Dus got sick with coronavirus, which she said eventually turned into pneumonia and pleurisy, an inflammation of the lungs. As an asthmatic, the combination hit her hard. 

That’s why she was set on getting a vaccine this year. She’d reviewed the list of medical conditions that put people at a higher risk of COVID-19. Moderate to severe asthma is included, so she figured she could get one.

When Dus asked the pharmacy worker at CVS, though, the answer surprised her. 

“She said, ‘You have to be over 65 or immunocompromised,’” Dus said. As defined by the CDC, immunocompromised can mean people receiving chemotherapy for cancer or who have immune deficiency diseases. Asthma is not included in the definition. 

Dus said she pushed back, but the worker was firm. Dus later shared her experience on social media. Responders told her she was qualified to get the vaccine. A few days later, Dus went to another CVS pharmacy in Northeast Ohio, where a pharmacist confirmed that she was eligible and gave her the shot. She wasn’t asked to pay anything for the shot out of pocket.

Dus was relieved but frustrated. She wondered what the confusion around the vaccine means for those who don’t have the resources she does – a partner to watch her toddler while she visited another pharmacy and time to research the vaccine online.  

“I’m not juggling multiple part-time jobs or having to do all of this on my own,” Dus said. “Frankly, all of those things could have prevented me from being able to go above and beyond and ultimately get this vaccine for myself.” 

CVS did not respond to questions about how it is keeping its pharmacy staff updated on COVID-19 vaccine regulations. In a statement, a spokesperson said that Dus “should have been able to receive the vaccine as asthma is a condition that puts someone at high risk.”

Paying out of pocket for the vaccine

Lindsay Davis sees getting a COVID vaccine as a necessity.

The former Miss Ohio is a heart health advocate who convinced the state’s legislature to pass a law in 2017 to protect youth athletes from sudden cardiac arrest. 

As a teenager, she nearly died from a cardiac arrest while training as a dancer – all due to a serious heart condition that also makes her vulnerable to COVID-19. 

“When I got COVID several years ago, I ended up hospitalized with heart complications,” Davis said. “I needed infusions, and I’m still dealing with lasting damage from COVID. … The vaccine is one of my only tools I have to avoid going through that kind of trauma again.”

Davis is not just worried about her health: she said her mom currently has Stage 4 cancer.

So she set out early this September to get a vaccine. When Davis got to the pharmacy, she was told she could get the shot. It just wasn’t covered by insurance. She had to pay out of pocket — about $200. 

“I was told things like, ‘My condition didn’t qualify for coverage, and only adults over 65 were covered,’” Davis said. 

The situation infuriated her. 

“When patients who clearly qualify under national guidelines are still told no, it shows the system isn’t just broken,” Davis said. “It’s breaking the very people it’s supposed to protect.”

Davis said a representative from her insurance later told her she needed to get prior authorization from a medical provider in order to get the shot covered.

Older adults breeze through 

Several people over 65 whom Signal Cleveland spoke with had a far easier time getting the shot.

Michael Hardy, a 78-year-old, said he had “no problem” getting a vaccine at a Beachwood pharmacy. 

He said he’s gotten a COVID vaccine each year since the pandemic. He observed many vaccine-preventable diseases growing up, he said, which inspired him to keep getting the shots. 

“I had measles. I had, you know, I had shingles,” Hardy said. “…If I had an opportunity for a vaccine, I will take it.”

Hardy’s insurance covered the vaccine, he said. 

Rachel Schwarz, a 71-year-old, also said the process to get a shot at a pharmacy had no hiccups. She wanted a vaccine to keep her husband, who’s in a long-term care facility, safe. 

She said she got the shot earlier in the season than she normally would, out of worry that federal changes coming down the pike would restrict her access. 

“I did fear that … they could just say, ‘OK, we’re not going to do it at all,’” Schwarz said.