When Politics Meets Science: The Current COVID Vaccine Landscape
It's deja vu all over again
ICYMI 👉
💊 TODAY at 5 pm ET! Join me for a live conversation with primary care doctor and medical writer, Adam Cifu, MD, to discuss
the new COVID vaccine guidelines
who to trust in medicine and public health
where to get evidence-based medical information
It’s a jungle out there. Join us here!
Last week brought a flurry of announcements about COVID vaccines that left many of my patients—and frankly, many healthcare providers—confused and concerned. The FDA outlined new approval standards for future COVID vaccines, the CDC changed its recommendations for children and pregnant women, and through it all, the intersection of politics and public health has never felt more glaring.
My palms started sweating as I witnessed COVID vaccines being used as political football—again. So, today I’ll walk you through what's actually happened, why it matters for your health, and what I'll be recommending to my patients come this fall.
What Actually Changed This Week
The FDA's New Approach
The Food and Drug Administration announced it will now require different standards of evidence for COVID vaccine approvals based on risk groups. For people 65 and older and those with underlying conditions (which includes about 100-200 million Americans), the agency will continue to accept immunogenicity data—essentially proof that vaccines trigger a strong immune response—as sufficient evidence for approval.
But for healthy adults and children under 65? The FDA now wants to see full clinical trials proving the vaccines prevent symptomatic COVID with at least 30% effectiveness. This is a significant departure from recent years, when updated vaccines were approved based on immune response data alone.
You might be surprised to hear that I agree with much of what FDA head Marty Makary, MD, and vaccine czar Vinay Prasad, MD, wrote last week in the New England Journal of Medicine about the COVID vaccines. I agree with Dr. Cifu’s comment about their article here:
The article takes a sensible, transparent, and evidence based approach to future COVID vaccine policy. The plan sets a low bar for COVID vaccine approval for high risk patients and a high(er) one for low risk patients. The policy suggests better alignment with our European peers.
Dr. Cifu and I will discuss this guidance later today here.
The CDC's Shifting Stance
Meanwhile, right after Health Secretary Robert F. Kennedy Jr. announced that COVID vaccines would be "removed" from recommendations for healthy children and pregnant women, the CDC updated its guidance with more nuance. Basically, the CDC overrode RFK. Per the CDC, for children 6 months to 17 years, COVID vaccines are now recommended through "shared clinical decision-making,” meaning parents and doctors should discuss what makes sense for each individual child.
For pregnant women, the CDC guidance has become less clear, with some pages showing no specific recommendation.
The Politics vs. Science Problem
Here's what kills me about this whole situation: when politics drives health policy, everyone loses. We’ve seen what happens when scientific evidence gets tangled up with political messaging. People stop trusting their doctors. They stop trusting institutions. And ultimately, they make health decisions based on fear and ideology rather than facts and individual risk assessment.
The truth is, COVID vaccine policy should be more nuanced than it has been. Not everyone faces the same risk from COVID, and not everyone benefits equally from repeated boosters. This has been evident for years, but acknowledging this biological reality was politically fraught from the get-go. Even in 2022, after most Americans had some immunity to COVID (from the vaccine or from infection or both), those of us who argued publicly for more nuanced messaging about COVID risks and COVID shots were deemed right-wing operatives. It was bonkers.
The introduction of the COVID vaccine in late 2020 was a wonder of modern science. But what frustrated me during the pandemic is what makes my head spin now—that reasonable, evidence-based conversations about targeted vaccination strategies got caught up in broader vaccine skepticism and political positioning. The result? Policy changes that feel abrupt and confusing, announced by inflammatory headlines that only gin up fear and outrage.
What This Means for You
Despite the political noise, the fundamental science hasn't changed overnight. COVID vaccines remain highly effective at preventing severe illness, hospitalization, and death, especially in high-risk groups.
Here's what we know:
People 65 and older remain at highest risk for severe COVID outcomes
Those with underlying conditions like diabetes, heart disease, obesity, asthma, and immunocompromising conditions benefit significantly from vaccination
Pregnant women face increased risks from COVID infection that can affect both mother and baby
Healthy young adults and children have much lower baseline risk, though COVID can still cause serious illness
My Recommendations for Fall 2025
When the updated COVID vaccines become available this August and September, my advice will be consistent with what I've been telling patients for years: focus on those at highest risk.
I will strongly recommend the updated vaccine for:
All patients 65 and older
Anyone with diabetes, heart disease, lung disease, kidney disease, or immunocompromising conditions
Pregnant patients (regardless of changing political winds—the science on maternal and fetal benefits is clear)
Healthcare workers and caregivers of high-risk individuals
For healthy adults under 65: I'll have individualized conversations. Some may benefit from vaccination based on their specific circumstances. Maybe they care for elderly relatives, have jobs with high exposure risk, or simply want the added protection. Others may reasonably choose to forgo boosters if their personal risk is low.
What about kids and teens? I am not a pediatrician, so I defer to the experts. Personally, I won’t push COVID boosters this fall for my three healthy teen/young adult children. Why? Each of them has had the primary COVID vaccine series plus COVID itself, which renders the marginal benefit of another vaccine dose very small.
What about me? I probably will get the new COVID shot this fall because 1) I haven’t yet had COVID (shocker—I know), 2) I won’t have had a booster in over a year, and 3) I care for immunocompromised patients who may benefit from me having a fresh batch of COVID antibodies to fight COVID if I get it—that is, a booster shot may transiently reduce the risk of infection, and, therefore, the risk of transmitting the virus to others. Note, however, that the best way to protect other people from getting COVID isn’t necessarily another vaccine dose; it’s staying home from work or school when sick!
Sadly, not everyone will be able to make such nuanced decisions—100 million Americans don’t have a doctor to discuss it with. But this is exactly the kind of personalized medicine that every American deserves. It is what we should have been advocating for—and practicing—all along. Sigh.
Moving Forward: Reclaiming Rational Discourse
What I hope emerges from this messy moment is a return to nuanced, evidence-based discussions about health interventions. Not everything needs to be one-size-fits-all. Not every public health tool needs to be politically weaponized.
COVID vaccines are remarkably safe and effective tools, especially for protecting our most vulnerable community members. They're not perfect, they're not needed by everyone equally, and they shouldn't be the lightning rod for broader cultural battles about trust in institutions.
For my patients, here's what I want you to know:
When it comes to COVID risk, what matters most is your age, underlying health, individual risk factors, and immunity to COVID (from vaccine doses and the virus itself)
We can have honest conversations about benefits and risks without fear or judgment
Good medicine has always been about matching interventions to individual needs, with clear communication to boot
Health is about tradeoffs; it requires a consistent, honestly assessment of risk
I'm here to help you navigate these decisions based on evidence
A Question for You!
What's your biggest concern about the changing COVID vaccine landscape? Please comment and let me know—your questions help shape future newsletters!
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Disclaimer: The views expressed here are entirely my own. They are not a substitute for advice from your personal physician.
Dr. McBride,
As always, I appreciate your clear and balanced explanation of the COVID vaccine recommendations. I am a healthy 45 year old woman, with no risk factors, but I am a teacher and share the care of my 72 year old mother, who is in treatment for lung cancer and is immunocompromised. I would like to be able to get a booster in order to protect her, and to minimize the severity of a COVID infection if I do get it again. I hope there is room in the new guidelines for people in my situation. Not all risk is limited to an individual.
Once again, thank you for your expertise and common sense.
My main concern is that health policies have been put into the hands of people that are not of the medical/science community. Another concern is freedom of choice. Is this the beginning of banning future Covid or any other vaccines available? Will the millions who will lose their health insurance be able to pay for the vaccines?
Politicizing medicine is gravely dangerous. I will listen to scientists and my physician regarding my health over any politician. I just shake my head…