Loryn Competti was watching the news with her husband at their home in Cincinnati when she heard about the new federal policy about who should get a COVID vaccine.
"I started crying," says Competti. "I was like, 'Am I really not going to be able to get this vaccine? Why? Why?' That's absolutely terrifying."
Competti, 30, is about five months pregnant, which means she's at high risk for serious complications from COVID. But the Centers for Disease Control and Prevention has dropped its recommendation that healthy pregnant women routinely get vaccinated against the virus.
That means many insurance companies may not pay for the shots for them anymore.
"I don't want to get COVID while I'm pregnant," Competti says. "I don't want it to hurt my child. I don't want to have a premature birth. I just know that there's complications that come along with it."
She also knows that the most certain way to protect her newborn son is by getting vaccinated herself so she can share her antibodies in her womb. Newborn babies are too young to get a shot themselves.
Competti is just one of many people worried about a flurry of changes implemented by the Trump administration in recent weeks affecting access to the COVID-19 vaccines for healthy pregnant women, kids with no other health problems, and adults under 65 with no risk factors.
The CDC has dropped its recommendation that healthy children routinely continue getting vaccinated and is now saying parents should talk to their children's doctors about getting the shots.
And, starting with new boosters coming this fall, the Food and Drug Administration will now only approve the shots for people who are at high risk for serious complications from COVID because they are age 65 or older or have risk factors for health problems that make them vulnerable. The FDA is demanding the vaccine companies conduct large, costly studies to prove the vaccines are still necessary and safe for everyone else.
Debates over existing recommendations
Administration officials argue the shots are no longer necessary for healthy pregnant women, kids and younger adults under 65 because so many people have so much immunity at this point.
Officials like Health Secretary Robert F. Kennedy Jr. and FDA Commissioner Martin Makary also question the safety of the vaccines, even though billions of people have gotten the shot and there's widespread consensus among most public health and infectious disease experts that the shots are very safe and effective.
With most Americans declining to get COVID shots anyway, many people are indifferent to the changes. In social media responses received by NPR, some people said they were happy to see the changes, claiming the vaccines harmed them. And some outside observers agree with the changes.
"I think the pre-existing COVID recommendations, especially for anyone over 6 months of age, were pretty ridiculous and pretty extreme," says Judge Glock, director of research at the Manhattan Institute, a conservative think tank. "I think this aligns with what we do know about the current science about the vaccines and the current risks and rewards of vaccination."
The recommendation that parents of children may still get the shots after talking with their doctors could mean that insurers would still pay for the shots, but that's not guaranteed.
"Based on my collective observations of payer coverage of vaccines, the bottom line is to expect variability in coverage," says Richard Hughes, a health care policy lawyer who's following the issue.
Competti and others for whom the vaccines are no longer recommended or approved may still be able to access the vaccines because doctors could prescribe them "off-label," enabling people to pay for them themselves. But the shots can cost as much as about $200 each. Children getting their first vaccinations require two injections.
Competti knows she will probably still be able to get vaccinated by paying for a shot herself. But all the uncertainty and changing rules makes her anxious.
"If we're losing access to COVID vaccines, I don't know if other things are going to get taken away," she says. "I'm scared."
Another concern is the moves may confuse many doctors, pharmacists and other health professionals, making some hesitant to offer the shots even if they could.
"These new HHS changes, in the absence of any justification, fuel myths and misconceptions about COVID vaccines," says Kelly Moore, president and CEO of Immunize.org, an advocacy group.
"Conflicting recommendations, with professional medical societies on one side and HHS leadership on the other, will generate tremendous confusion among health care professionals and the public," Moore says. "People who are confused don't act. Their default is not to vaccinate."
Getting vaccinated to protect a family member
Healthy pregnant women aren't the only people who are worried about access to the shots.
Ashley Hoskins, 45, and her husband, Bob, 50, who live in Nashville, Tenn., with their young daughter, also want to keep getting vaccinated. That's because Bob has to take powerful immune system suppressing drugs to prevent his body from rejecting his transplanted kidney.
"He's at a heightened risk to catch everything," Ashley Hoskins says. "So not only do we have to worry about whether or not he can receive vaccines. We have always had to be vaccinated as well to provide another wall of protection around him."
Bob Hoskins will still be able to get a shot. But now Ashley Hoskins and her daughter worry about whether they will too.
"Blanket decisions like this — it doesn't allow the families to think about their own private situation," Ashley Hoskins says. "How do we protect the people that we love? People are going to get hurt. So, yeah, it's frustrating. It's scary."
Rachel Sampler Zelaya, 42, of Cottage Grove, Minn., is concerned too.
Her 6-year-old daughter, Lucia, has asthma. So Zelaya wants to keep getting herself, her husband, Jorge, 45, and their two other healthy kids, Jorgito, 9, and Clara, 11, vaccinated to protect her too. But none of them would be automatically eligible except the youngest under the new policies.
"I'm angry," Zelaya says. "It feels like I've had a choice taken away from me."
Some administration officials, however, question whether vaccinating one person protects those around them.
"To date there is no high-quality evidence that you getting a booster to visit your grandma protects your grandma beyond your grandma getting the booster herself," Dr. Vinay Prasad, director of the FDA's Center for Biologics Evaluation and Research, which oversees vaccines, said on a CDC video. "Does it lead to less transmission? Does it lead to fewer instances of severe disease? We are interested in evidence to inform this claim."
But other experts question that argument.
"Basically it seems common sense that vaccination, to the extent it reduces infection frequency or severity, could help protect others you may come in contact with," said Dr. Jesse Goodman, a former FDA vaccine official now at Georgetown University.
This would make sense, Goodman says, "given that the vaccinated may have less frequent infections in the three to six months after vaccination and given that some studies suggest there may be reduced shedding of virus."
For Hoskins, she's not just worried about protecting her daughter. She also wants to shield the whole family to protect everyone's health.
"It's not just a cold. It affects the vascular system, the neurological system, the immune system. And even mild cases have the potential to develop into long COVID," she says. "We vaccinate for far less. And this is definitely a disease to me that needs to be vaccinated for."
Suddenly having to worry about the vaccines again feels like a flashback to the early days of the pandemic, she says.
"It feels like we are going back in time again to where there's not a whole lot that I can do to protect my kids," she says.
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