Restricting COVID-19 Vaccine Access Risks Wider Gaps in Protection and Trust

The FDA’s recent COVID-19 vaccine update approvals that target older adults and high-risk individuals are raising concerns that limiting access for other populations could leave millions of otherwise healthy or moderately at-risk people exposed to infection, hospitalization, long COVID and other complications.

Jennifer Walsh, D.N.P., C.P.N.P., CNE, assistant professor at George Washington University School of Nursing, told Managed Healthcare Executive that restricting vaccine eligibility will impact the availability and uptake of vaccinations, “exposing more people to infection, hospitalization, risk of long-COVID and risk of death.”

Walsh, D.N.P., C.P.N.P., CNE

She expressed that insurance coverage and programs such as Vaccines for Children (VFC) may not extend to those outside the recommended groups, disproportionately affecting lower-income or marginalized populations.

“It negates the well-researched benefit of vaccination in pregnant women and infants and toddlers,” she said.

Walsh highlighted the broader public health effects of limiting access.

“We have to also think about the opportunity vaccination provides to protect the community and those with loved ones that may be at increased risk,” she said. “Individuals who are immune-compromised, taking immunosuppressants, and those receiving treatment for cancer are at increased risk of COVID and its negative outcomes. They deserve to live in a population which values reducing the risk of vaccine-preventable diseases.”

Infants, young children and healthy adults also face increased risks if vaccine access is scaled back.

Noting that the American Academy of Pediatrics (AAP) highly recommends vaccination for children between the ages of 6 and 23 months, Walsh pointed out that children under the age of two are one of the highest risk groups for hospitalization related to COVID. In addition, over half of all children hospitalized due to COVID have no underlying health issues.

She noted that excluding these groups from recommendations could limit vaccine availability and send a message that protection is unnecessary.

“Limiting recommendations for COVID vaccination makes protecting yourself and your family more challenging and more expensive—further creating an even greater divide between access and socioeconomic status,” she said.

Walsh also warned that restrictions could threaten public confidence in vaccines and health guidance.

“When the government, which is entrusted to protect its citizens, restricts vaccination in any way, they are sending a message that it is not important, further adding to vaccine hesitancy,” she said. “This has the potential to significantly impact access, create greater disparities, reduce population immunity, and further fuel distrust in health guidance, even though there is ample evidence to support vaccination.”

For clinicians and primary care providers, Walsh emphasized the importance of addressing patient concerns by stating that they should “welcome open conversations” that address patient concerns and confusion.

“They should communicate the very real risk of disease and the benefits and safety profile of vaccination,” Walsh added. “They should lean on their professional societies whose experts can help translate the evidence, such as the AAP, the National Association of Pediatric Nurse Practitioners, the American Medical Association, the Infectious Disease Society of America, the American College of Obstetricians and Gynecologists and the other 100+ medical associations made up of experts who have devoted their lives to improving the health of the population. And, finally, they should actively combat vaccine misinformation.”

Looking ahead, Walsh expressed that additional research is needed to inform future policy. With the amount of evidence there is on these vaccines that proves they reduce morbidity and mortality and that they are cost-saving, it now opens space for medical experts in their fields to lead and guide the government to make sound decisions regarding health policy, she added.

Maintaining trust in science-based recommendations is critical.

“Up until recently, (we had) trust that the CDC and ACIP (were) focused on sound scientific research to guide health recommendations. We had trust that they were not focused on a political agenda of any kind,” she said, adding that research on how to better address vaccine hesitancy is crucial.

Walsh stressed that “vaccines work so well that individuals no longer fear these diseases and this has the potential to reduce their vigilance at protecting themselves and their loved ones against these diseases.”

As folks navigate vaccination decisions, Walsh’s insights highlight the ongoing need for accessible vaccines, clear guidance and policies that prioritize public health over political or logistical constraints.