For years, Governor Kim Reynolds resisted COVID-19 vaccine mandates, saying she believed “in Iowans’ right to make health care decisions based on what’s best for themselves and their families.”

But as this year’s cold and flu season begins, many Iowans who want to protect themselves and their families from COVID-19 are unable to get a booster shot, because the U.S. Food and Drug Administration restricted access to updated vaccines.

Public health authorities in about two dozen states have issued guidance or standing orders designed to help adults choose to vaccinate themselves or their children against COVID-19. The Reynolds administration has not acted.

Staff for the governor’s office and Iowa Department of Health and Human Services did not respond to several requests for comment over the past ten days.

TRUMP ADMINISTRATION SHARPLY REDUCES ACCESS TO COVID VACCINES

U.S. Health and Human Services Secretary Robert F. Kennedy, Jr. is among the world’s most prominent critics of routine vaccination. He has already “undercut U.S. vaccine confidence and access” in at least a dozen ways. Several of the policy changes targeted COVID-19 vaccines, which prominent conservative and MAGA voices have demonized since they were developed on a fast track during Donald Trump’s first presidency.

In May, the Food and Drug Administration (FDA) stopped recommending COVID-19 vaccinations and booster shots for pregnant women and children without a health condition putting them in a high-risk category. The policy was inconsistent with scientific consensus about the risks of COVID-19 infections and the safety of vaccines. Medical authorities including the American College of Obstetricians and Gynecologists and the American Academy of Pediatrics opposed the move, and public health experts expressed concern that the new federal government guidance could make COVID shots too costly for many low-risk individuals. (Insurance companies often align their coverage with FDA recommendations.)

Kennedy followed up in June by removing every member of the Advisory Committee on Immunization Practices at the Centers for Disease Control and Prevention. He claimed the new members would “prioritize public health and evidence-based medicine” and stop being “a rubber stamp for industry profit-taking agendas.” It didn’t take long for Kennedy’s new appointees to elevate anti-vaccine advocates over scientific consensus during committee deliberations.

In early August, Kennedy announced that the federal government was cancelling hundreds of millions of dollars in contracts to develop vaccines using mRNA technology. Although the secretary claimed there are “better solutions” than mRNA vaccines for respiratory viruses like COVID-19, public health and medical experts condemned the move.

The FDA took another giant step backwards in late August, when it ended emergency use authorizations for COVID-19 vaccines and approved the latest versions of the shots, but only for people who are at least 65 years old or have an underlying condition putting them at higher risk of severe infection. Kennedy claimed the vaccines would remain “available to people who want them.” That wasn’t true. NPR reported at the time,

The new restrictions on the updated COVID vaccines, which target the LP.8.1 omicron subvariant, mean insurance may no longer pay for the shots, doctors may balk at stocking and prescribing them, and pharmacists may be unable or unwilling to administer the vaccines.

“The restrictions are not following the science of what these vaccines can and will do,” says Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota. “This is a disaster waiting to happen.”

The FDA’s approval for new COVID boosters does not extend to anyone in close contact with vulnerable individuals, meaning that in many states, healthy adults and children can’t get vaccinated to protect those they live or work with.

“I’VE NOT HEARD OF ANYBODY THAT’S HAD DIFFICULTY”

I began hearing from Iowans in September who were unable to obtain a COVID booster at their local pharmacy, even if a household member or close contact had one of the medical conditions on the CDC’s list (such as cancer, asthma, or diabetes).

I knew officials in some other states were taking steps to keep the shots broadly available. So when Governor Reynolds had a rare press conference on September 24, I asked whether her administration would do anything to ensure that Iowans who choose to get a COVID booster have an opportunity to do so. My video of our exchange:

Reynolds denied the problem exists: “It’s my understanding that they can right now. I’ve not heard of anybody that’s had difficulty in getting those shots. If you’d like to give those individuals that you talked to our number, we’d be happy to talk to them and connect them with the administration. But it’s my understanding that that’s not actually the case.”

I tried to clarify whether Reynolds agreed “people should be able to get the shot,” including children whose parents are at high risk. The governor may have misheard my question, because she interrupted to say, “That’s not my decision. That is a parent’s decision and an individual’s decision.”

Sadly, no. Under the current FDA policy, Iowa parents cannot choose to get COVID boosters for a child who doesn’t have an underlying medical condition.

This isn’t theoretical for me: when I was in fifth grade, my mother was going through rounds of chemotherapy. Iowa families facing the same nightmare today can’t easily lower the risk of a child bringing a deadly virus home from school.

REYNOLDS ADMINISTRATION IGNORES FOLLOW-UP QUESTIONS

The morning after the governor’s news conference, I called one of Hy-Vee’s pharmacies in Polk County and confirmed that a person under age 65 seeking a COVID booster would need to attest to having one of the underlying conditions on the CDC’s list. The employee I spoke to had recently turned down a doctor who wanted the shot to protect his patients.

She told me Hy-Vee would honor a prescription for the vaccine. But not everyone has the time or money to schedule a doctor’s visit for that purpose. And not every doctor would prescribe a COVID booster based on a patient’s proximity to high-risk individuals.

I contacted the governor’s spokesperson, Mason Mauro, noting that some state public health officials have issued a standing order allowing COVID-19 vaccination for people over a certain age. (KFF is tracking state policies on vaccine access here.)

I wanted to know: Does Governor Reynolds think Iowans should be able to choose to be vaccinated, either to protect themselves or to protect others they spend time with? Will she do anything to ensure Iowans who want to be vaccinated, or want their children to be vaccinated, will be able to make that choice?

Mauro did not respond to that message or two follow-up emails.

I also reached out three times to the Iowa Department and Health and Human Services. Do agency leaders agree Iowans should be able to choose to be vaccinated, and will they make COVID boosters accessible? At this writing, I have received no reply.

“STILL WAITING FOR THE CDC DIRECTOR TO APPROVE”

After I posted my Q&A with the governor on social media, some readers questioned why pharmacies would not give COVID boosters to anyone who wants one. They pointed out that on September 19, the CDC’s Advisory Committee on Immunization Practices “unanimously recommended that vaccination for COVID-19 be determined by individual decision-making” for “all individuals six months and older.”

However, the FDA approval is still only for people who are at least 65 years old or have an underlying condition. Yale School of Public Health Associate Professor Dr. Jason L. Schwartz explained what that means in practice.

While it is not unprecedented for CDC/ACIP to endorse the use of a vaccine outside the margins of its FDA approval—what’s referred to as “off-label use”—it is quite uncommon and, unlike the widespread off-label use of pharmaceuticals, typically reserved for small populations in very limited circumstances. Here, ACIP has opened the door to off-label use of the vaccine for tens of millions of Americans, essentially all healthy individuals between 6 months and 65 years of age.

Still, this “shared clinical decision-making” guideline is a step down from the ACIP’s far more common, “routine” recommendations for vaccines.

Schwartz emphasized that the committee’s recommendations “are still pending adoption by the acting CDC director, at which point they would become official CDC guidelines. It is currently unclear when or whether the director will make that decision.”

Representatives of three large companies operating pharmacies in Iowa confirmed my understanding of current policy. In a September 26 email, Hy-Vee spokesperson Tina Potthoff acknowledged the ACIP vote “to recommend COVID-19 vaccines based on individual decision-making. However, retail pharmacies, including Hy-Vee, cannot adopt the new ACIP guidelines until approved by the CDC Director.” In the meantime, Hy-Vee pharmacies in states including Iowa “are currently following the FDA’s guidelines.”

A spokesperson for Walgreens provided a similar statement: “Once the Advisory Committee on Immunization Practices (ACIP)’s recent recommendation is adopted by the acting CDC director, Walgreens will offer the 2025-2026 COVID-19 vaccines at locations nationwide, to individuals three years and older, no prescription required.”

Same story from Amy Thibault on behalf of CVS: “We’re awaiting the CDC’s approval of the recommendations made by ACIP on September 19. As soon as approval is received, we will be prepared to implement nationwide.”

The White House fired CDC Director Susan Monarez in late August, following Kennedy’s push to oust her. That move prompted several other senior CDC officials to resign. There’s no guarantee acting CDC director Jim O’Neill—widely seen as Kennedy’s “operational right hand,” according to Politico—will ever adopt guidelines allowing healthy people to choose COVID boosters.

I checked back in with the pharmacy chains on October 3. “Everything remains the same in Iowa,” Potthoff wrote. “We are still waiting for the CDC director to approve.”

“WE DO NOT REQUIRE DOCUMENTATION”

Some low-risk Iowans have obtained COVID boosters by attesting to a high-risk condition on the intake form. The Hy-Vee employee I spoke to last month indicated that anyone claiming to have an underlying condition could get a shot: “We’re not the judges of it, so if you mark yes on question 7, then we process it.”

Thibault told me CVS has a similar policy: “Patients in Iowa can get the vaccine if they confirm would like to receive the COVID-19 vaccine and that they are eligible during the appointment scheduling process on the CVS Health app and CVS.com, or at the pharmacy or MinuteClinic when the patient is completing the health screening form.” If and when the CDC approves the wider recommendations for COVID boosters, CVS will remove that question from the scheduler.

It’s important to note that Iowans under age 65 can’t get a vaccine just by stipulating that they spend time around someone whose health is vulnerable (for instance, as a caregiver for a special needs child or elderly parent). They must say they meet the criteria. Thibault explained, “If a patient tells us they are eligible, they will be given the vaccine. We do not require documentation.”

I would not advise claiming to have any health condition that hasn’t been diagnosed. My concern is that making a false statement could give an insurance company grounds to void a policy later.

If Reynolds truly believes in “Iowans’ right to make health care decisions based on what’s best for themselves and their families,” she could solve this problem quickly through executive action. The Iowa Department of Health and Human Services could issue a standing order like those in place in many Democratic-led states.

Iowans who have had trouble getting a COVID-19 vaccine can call the governor’s office (515-281-5211) or submit feedback online.

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Appendix: Full transcript of Governor Kim Reynolds responding to Laura Belin’s question about COVID booster shots during a September 24, 2025 news conference

Belin: Governor, I’ve heard from some people who are very concerned about not being able to get their COVID-19 booster shot. I talked to a doctor yesterday who said that if somebody is living with someone who’s going through chemotherapy, or has asthma or diabetes, they can’t get the shot. Only the patient can get the shot. I talked to somebody who was turned down from a Hy-Vee; she has a daughter-in-law with asthma and a young grandchild. Is your administration going to do anything to make sure that Iowans who choose to get the booster shot have an opportunity to get it?

Reynolds: It’s my understanding that they can right now. I’ve not heard of anybody that’s had difficulty in getting those shots. If you’d like to give those individuals that you talked to our number, we’d be happy to talk to them and connect them with the administration. But it’s my understanding that that’s not actually the case.

Belin: So you think people should be able to get the shot? Does that include children who might have a parent—

Reynolds (interrupting): That’s not my decision. That is a parent’s decision and an individual’s decision.