As COVID-19 cases surge across California and Hawaii in early September 2025—reaching levels not seen since the previous year—Americans are facing a confusing new landscape for vaccinations, marked by shifting eligibility, political infighting, and uncertain insurance coverage. While the virus no longer holds the same grip it did five years ago, when it unleashed a global pandemic and led to sweeping government mandates, it remains a persistent threat, especially for seniors and those with underlying health conditions.
In both California and Hawaii, the fall respiratory virus season is approaching amid a wave of new infections. According to the Bay Area News Group, concentrations of COVID-19 in wastewater remain high throughout the Bay Area, and hospitalizations are on the rise. Alameda County saw an increase from 17 COVID-19 hospitalizations in June to 73 by the week of August 18, 2025, and Santa Clara County’s hospitalizations nearly doubled from 32 in early June to 59 by August 24. Hawaii, meanwhile, reported test positivity rates peaking at 16.1% in early August and holding at 13.7% for the week ending September 1, according to the state Department of Health’s COVID-19 dashboard. Children under 11 also experienced a spike in emergency department visits for COVID-19 in August, the CDC reports.
Despite these upticks, the overall severity of the disease has lessened compared to the darkest days of the pandemic. In Alameda County, for example, only one COVID-19 death was reported in the last week of August, a far cry from the more than 80 weekly deaths seen in January 2021. Still, for the most vulnerable—seniors, young children, and those with preexisting conditions—the risks remain real, and public health officials continue to urge vaccination and, in some settings, masking.
Yet, for those seeking the latest COVID-19 shot, the path has never been more tangled. The U.S. Food and Drug Administration (FDA) approved updated COVID-19 vaccines in late August 2025, but only for people ages 65 and older and for younger individuals with at least one high-risk medical condition, such as cancer, obesity, or heart disease. This marks a significant departure from previous years, when vaccines were authorized for anyone aged six months and up. The result? Widespread confusion about who is eligible, where to get vaccinated, and whether insurance will cover the cost.
“Never has our population been more confused than now,” said John Swartzberg, a clinical professor of infectious diseases and vaccinology at the UC Berkeley School of Public Health, in comments to the Bay Area News Group. The uncertainty is compounded by conflicting guidance from federal, state, and local authorities, as well as by ongoing political turmoil within the nation's public health agencies.
Earlier this year, U.S. Health and Human Services Secretary Robert F. Kennedy Jr.—a figure known for his vaccine skepticism—replaced the entire CDC Advisory Committee on Immunization Practices, appointing several doctors and researchers who have publicly questioned vaccine safety. Kennedy also announced the removal of COVID-19 shots for healthy children and pregnant women from the government’s immunization schedule, a move that has drawn sharp criticism from leading medical organizations. The CDC’s new advisory panel is set to meet on September 18 and 19, 2025, to reconsider vaccine recommendations, leaving insurers and providers in a holding pattern until new guidelines are issued.
“It’s going to be harder,” said Dr. Scott Miscovich of Premier Medical Group Hawaii, as quoted in the Honolulu Star-Advertiser. “A major reason why, first of all, is finding these in your regular doctor’s offices is really going to be minimal.” Miscovich expressed concern about the logistics of vaccine distribution, with doctors hesitant to order large quantities of vaccines that may go unused. He also noted that insurance companies may become stricter in evaluating whether younger patients meet the criteria for a shot, potentially reducing vaccine uptake by as much as 30% in Hawaii compared to previous years.
Retail pharmacies like CVS, Walgreens, and Longs Drugs are offering the updated vaccines to eligible groups. In California, CVS will administer the shot to healthy people outside the FDA-approved categories only if they have a prescription from their doctor, but the criteria for such prescriptions remain unclear. And for those without insurance, the out-of-pocket cost is steep—$150 or more per dose—posing a significant barrier to access.
The insurance landscape itself is a patchwork. In Hawaii, HMSA, one of the state’s largest insurers, said it will continue to cover COVID-19 vaccines without cost sharing for anyone over six months old who desires one. “We believe that everyone in Hawaii who wants one should have access to one,” said Stefanie Park, HMSA chief medical officer, in a statement. Kaiser Permanente, the largest insurer in California, is also committed to making the 2025-26 COVID vaccine available at no cost to children and adults for protection from severe illness, pending final recommendations from the CDC and relevant medical societies.
State leaders are stepping in to fill the void left by federal indecision. California Governor Gavin Newsom announced that his state would develop its own “science-based” immunization recommendations in partnership with Washington, Oregon, and Hawaii, forming the West Coast Health Alliance. The alliance’s goal, according to a news release, is to provide “evidence-based immunization guidance rooted in safety, efficacy, and transparency—ensuring residents receive credible information free from political interference.” Hawaii’s Department of Health echoed this commitment, with State Epidemiologist Dr. Sarah Kemble stating, “The DOH believes that all individuals aged 6 months or older who desire COVID vaccination should have access to it, and DOH encourages health plans to cover COVID vaccination without cost-sharing, even if it’s for an indication that the U.S. FDA has removed.”
Not everyone is on board with these state-led efforts. In response to the West Coast alliance, HHS Communications Director Andrew Nixon criticized what he called “Democrat-run states that pushed unscientific school lockdowns, toddler mask mandates, and draconian vaccine passports during the COVID era,” arguing that such policies eroded public trust in health agencies. The political divide is stark, with states like Massachusetts requiring insurers to cover the cost of COVID-19 shots, while Florida has moved to end all state vaccine mandates.
Professional medical organizations have also weighed in, often contradicting the federal government’s new, more restrictive stance. The American Academy of Pediatrics recommends COVID-19 vaccination for all children ages 6 to 23 months, as well as older children in certain risk groups. “Parents who want one for their child should be able to get one,” the academy said, with its president, Dr. Susan Kressly, calling the decision to limit vaccine availability for children “deeply troubling.” The American College of Obstetricians and Gynecologists continues to recommend vaccination for all pregnant individuals.
Despite the confusion and controversy, public health officials remain steadfast in their core message. “Getting vaccinated continues to be the best way to protect yourself from COVID and other serious illnesses,” a spokesperson for the Santa Clara County public health department said. Dr. Miscovich added, “The COVID vaccination is absolutely safe; the data is crystal clear. You should be looking at it as very similar to a flu vaccination. COVID is with us to stay, and it is not something you want to get.”
With the fall season looming and COVID-19 cases rising, the coming weeks will test whether state alliances, insurers, and pharmacies can work together to ensure that those who want protection from the virus aren’t left behind by shifting rules and political wrangling. For now, the only certainty is that the debate over COVID-19 vaccines is far from settled, and the stakes—for public health and for trust in America’s health institutions—couldn’t be higher.
