By Whitney Curry Wimbish

Copyright prospect

The United States is leading the world in COVID-19 deaths. Fourteen states have “very high” wastewater levels of the disease. There is still no cure for long COVID, which sickens 6 out of every 100 people who become infected and can cause serious indefinite disability.

None of that matters, according to anti-vaccine nut Robert F. Kennedy Jr., the secretary of health and human services. No, he has pledged to Make America Healthy Again by reducing access to modern medicine.

His chief weapon is confusion, on display shortly after the Food and Drug Administration changed its COVID vaccine guidance late last month to approve the shot only for people at least 65 years old and adults with one of a short list of medical conditions. At a hearing last week, he gave one contradictory statement after another, including during a six-minute exchange with Sen. Elizabeth Warren (D-MA). He’s not taking vaccines away, he claimed repeatedly. But the vaccine is not recommended for healthy people. Most Americans can get the vaccine from their pharmacy for free. But also, it depends on the state.

The practical result of such gobbledygook is that, as Warren said, Kennedy is “effectively denying people the vaccine.”

Also on display last week was Kennedy’s dishonesty; he claimed nobody knows how many Americans died of COVID at the height of the pandemic (the estimate is 1.2 million, almost certainly an undercount). So too was his lunacy, which has been so extensively documented that it is difficult to understand how he has public credibility in any capacity. Earlier this year, he swam in Washington, D.C.’s Rock Creek, with his grandchildren, not far from signs warning to stay out because of sewage runoff. Last month, he claimed he could diagnose a child with “mitochondrial challenges” simply by looking at them. And that’s to say nothing of the dead bear cub, chainsawed-off whale head, mice blitzed in a blender, or freezer full of roadkill. This is the man in charge of our national health; he is off his chump. Warren and other Democratic lawmakers demanded he resign. So did his family. Several days later, he still has his job and people are still confused about the COVID vaccine. Powerful actors, including every Republican senator except Mitch McConnell (R-KY), are again showing that they don’t mind mass death.

ABANDONED BY FEDERAL LEADERSHIP, officials in states across the country have tried to do what they can to protect their residents.

Governors in California, Oregon, and Washington last week pledged to work together to create their own vaccine guidelines, via their West Coast Health Alliance, a second iteration of the pact they formed at the height of the COVID pandemic. A few days later, Hawaii announced it was joining the group.

In Massachusetts, Gov. Maura Healey is allowing pharmacies to administer a COVID vaccine to anyone who wants it over five years old. She’s requiring insurance carriers to cover vaccines that the state public-health department recommends, the first in the country to do so, and announced a Northeast state alliance similar to the one in the West.

The Pennsylvania State Board of Pharmacy voted to allow pharmacists to follow vaccine recommendations of “trusted authorities,” including the American College of Obstetricians and Gynecologists, which recently recommended that pregnant people get a COVID vaccine at any point during pregnancy.

As of Friday, Colorado Gov. Jared Polis—who has previously praised Kennedy, incidentally—is also allowing pharmacists to give the vaccine to anyone who wants it without individual prescriptions.

New York Gov. Kathy Hochul declared a state of emergency on Friday and issued an executive order allowing pharmacists to prescribe and administer COVID vaccines to residents who request them.

Minnesota Gov. Tim Walz on Monday likewise issued an executive order, directing the state department of health to issue a standing order or protocol for COVID vaccine access by September 24 and announcing that the state will work with health plans to limit vaccine costs.

Maryland and New Mexico also took action to make sure residents could get a COVID shot if they wanted one.

But confusion is the theme here, too, and it’s unclear how some of the projects would affect who can get the vaccine, where, and when. State officials at the West Coast Health Alliance, for example, did not respond to questions about what coordinated guidelines at the state level would mean for the actual acquisition and administration of vaccine doses to individuals, or when the guidelines would be announced. Officials initially responded to emails from the Prospect and welcomed questions, then did not respond to the questions themselves, such as whether the states would buy vaccines directly from manufacturers.

AS OF FRIDAY, NEW YORKERS WERE SUPPOSED to be protected by Hochul’s executive order. But though I had a prescription for a vaccine from my doctor, calls to two CVS locations and three local pharmacies found that nobody knew where or when I could get it fulfilled. Pharmacists at both said they had none of the vaccine in stock; a pharmacist at one local shop said they weren’t planning on offering it at all this year. A spokeswoman at CVS said the company hoped to begin offering appointments by Saturday. But Saturday came and went, and appointments were still not available, so the next day I took the train to Hoboken, where they were. The rain was pouring down.

Booking the appointment required I attest to an underlying condition, and just in case, I brought the prescription and attestation from my doctor. But when I arrived, nobody asked for that, or my insurance card, or payment. The pharmacist said, “There’s a lot of you guys” coming across the Hudson, then added, “Welcome! We will vaccinate you.” She swabbed my arm, gave me the jab, then a green Band-Aid, and told me about her dog.

She commented that she didn’t get why people had to go across state lines just to get the vaccine, and added that at a meeting several days ago she heard that some states were stocking up for vaccine visitors. Then she called the next person.

Later, I contacted state officials, doctors, and legal professors about whether there’s anything stopping people from attesting to an underlying condition without proof. Is there a fine? No one answered directly, but they overwhelmingly said pharmacies would likely stick with self-attestation alone, which means checking a box and leaving it at that. If pharmacists at one place are testy about it, customers are free to take their business elsewhere, they said. They also noted that not everyone has time to run around to try to get a vaccine and that the entire situation constitutes a failure of public-health policy.

ALL OF THIS IS PART OF KENNEDY’S WAR OF ATTRITION on vaccines. Confusion is a form of deterrence, medical experts said, and does nothing but serve the agenda of anti-vaccine crusaders like Kennedy. Even if pharmacy administrators have the capacity to order vaccine doses, they may be reluctant to do so without clear authorization at the federal level, said Dr. Dave A. Chokshi, a physician at Bellevue Hospital and professor at the CUNY Graduate School of Public Health and Health Policy and a former health commissioner of New York City.

Americans are already confused, apathetic, or distrustful of vaccines: The number of children who received all recommended doses of vaccines declined nationwide between 2019 and 2023, for example, but the drop exceeded 10 percent in Nebraska and Minnesota. That’s the backdrop of COVID vaccine confusion, said Chokshi, and he’s worried about how that may extend to hesitancy toward RSV and flu vaccines.

And, he noted, it’s not like viruses respect state boundaries, including states with “very high” levels of COVID in the wastewater: California, Texas, Florida, North Carolina, Indiana, South Carolina, Alabama, Louisiana, Connecticut, Utah, Nevada, Idaho, Hawaii, and Alaska, and the District of Columbia. The fallout of Florida’s decision to end vaccine mandates for schoolkids, for example, won’t just stay in Florida. “A fragmented approach to vaccines leads to fragmented outcomes,” he said.

Chokshi, who chairs the Common Health Coalition, called on local governments, pharmacy boards, health care delivery systems, and insurers to coordinate and act in the absence of federal governance, and said it was especially important for health insurance companies to be explicit with their members that they will pay for the cost of COVID vaccinations. After all, it even makes business sense. Vaccination has been demonstrated to cut the risk of infection, severe disease, and long COVID, whose complications can be very expensive to treat.

Dr. Alan P. Sager went further. The professor at Boston University School of Public Health said that consternation over the COVID vaccine is nothing but a “sideshow” to a much graver problem that the U.S. political establishment refuses to acknowledge. The U.S. spends twice as much per person on health care as comparably rich democracies, with worse outcomes, including lower life expectancy, including for people with insurance.

That’s the main show, he said. Every peer nation has figured out universal health care, and implementing it in the U.S. would cut costs and improve national health. But in general, elected officials lack “compassion, competence, or ability to get any of this right,” and so states are left treading water.

“The alliances are meaningless public relations. I don’t think they have any legal or practical meaning,” Sager said, adding that one advantage is that states advertising the safety and need for vaccines could change public perception. But that’s not the same as buying the vaccine and administering it themselves. There’s nothing stopping them from doing that, he said.

“It’s a commercial transaction, you’re not dealing with fentanyl here, these things are not toxic despite what a tiny number of wackos think, so just go do it,” he said.