The Politics of Access

No matter how you feel about COVID vaccines, one thing should be nonnegotiable: anyone who wants to get one should be able to without cost being the barrier. Politics shouldn’t decide who gets vaccinated and who doesn’t. Yet this fall, if you’re a healthy 40-year-old walking into a CVS, you might be told the new booster will cost you $140.

That’s not because the vaccine suddenly got less safe or less effective. It’s because the FDA decided the updated COVID shots should only be officially approved for people 65 and older and those with certain high-risk conditions. And because the CDC is expected to match that guidance, insurance companies are no longer required to cover it for everyone.

On paper, the vaccine is still “available to anyone.” But in practice, for millions of people, it’s been moved into the category of things you can get but might not be able to afford. It’s basically the same way courtside Knicks tickets are available to me (if watching Jalen Brunson up close was able to save my life).

The science hasn’t changed: COVID vaccines are safe and effective, saving millions of lives. What’s changed is how leaders choose to talk about them.

Donald Trump, who once claimed credit for Operation Warp Speed, now demands that drug companies “prove” vaccines work — even as he admits he’s seen extraordinary evidence that they do. RFK, as Health Secretary, insists the shots are “available to anyone,” while backing an FDA framework that makes coverage optional for insurers.

What they are doing is a neat rhetorical trick: declare freedom of choice while making it prohibitively expensive to exercise that choice. How American!

When it comes to COVID vaccines, leaders rail against mandates and government overreach. But by narrowing coverage, they’re dictating access just the same. Meanwhile, with compounded GLP-1s and other peptides sold online without FDA approval, those same leaders shrug and say, “Let people choose.”

So which is it? A healthcare free-for-all where everyone decides for themselves, or a system with guardrails set by experts? You can’t flip-flop depending on what polls better. Yet that’s exactly what’s happening.

This is the core hypocrisy that defines so much of American healthcare politics. The same politicians who decry government intrusion when it comes to masks or vaccine mandates will happily embrace government restrictions when it scores political points or saves insurers money. They’ll shout about personal liberty in one breath, and in the next, design systems that make exercising that liberty prohibitively expensive. It’s not about principle; it’s about aligning with whichever stance delivers the best headline or the biggest campaign check.

Back in June, I wrote about how compounders hijacked the Ozempic shortage in my newsletter “From the FDA to Instagram: How Ozempic Got Hijacked by Compounders”. Their defense was patient choice: if someone wants a compounded version made overseas, why stop them? The FDA so far has looked the other way. But with COVID vaccines, politicians suddenly want to draw hard lines.

Kennedy and Trump don’t trust the FDA to decide what’s safe, but they’re fine letting the FDA decide who deserves access.

Because it’s not about principle. It’s about politics.

“Availability” doesn’t mean much without coverage. Anyone can ask their doctor for a shot off-label, but pharmacists in many states can’t give vaccines outside CDC recommendations. CVS has already said its pharmacies won’t offer COVID shots in 16 states and Washington DC for this reason. And even if you find someone willing, most won’t pay $140 out of pocket for something that used to be free.

In American healthcare, cost is the most powerful form of rationing. We’ve seen it with insulin. We’ve seen it with GLP-1s. Now we’re seeing it with COVID boosters. PBMs play the same game: they can’t force you to use their pharmacies, but they can make it financially advantageous — and that’s often enough to tip the scales. I devoted an entire newsletter to this dynamic — and the vaccine debate is just another version of the same trick.

This is about more than just the COVID vaccine. It’s about how we govern healthcare and how cost is weaponized to gatekeep access. If you believe in total freedom of choice, you have to accept the risks: bad actors, misinformation, and patients left to judge safety without training. If you believe in checks and balances, you have to trust agencies like the FDA and CDC to make evidence-based calls, even when unpopular.

But the truth is that the US has never been consistent on this. We already allow enormous freedom in supplements, where products can be marketed with flimsy science under DSHEA. We already allow gray areas in compounding, where “personalized medicine” often means sidestepping regulation. And at the same time, we enforce strict coverage rules around vaccines, childhood immunizations, and controlled substances. The pendulum swings not on principle, but on politics.

What we can’t do is bounce between the two whenever it’s politically convenient. That’s how you end up with vaccines that are safe, effective, and technically “available” — but not truly accessible.

COVID vaccines remain one of the safest, most effective tools we have. They’re not experimental or dangerous. They’re boring — in the best possible way. But politics has a way of making boring things expensive.

And if COVID vaccines can be downgraded to “optional luxuries,” what does that mean for flu shots, RSV vaccines, or even childhood immunizations? If the model becomes: available, but only if you can pay, the public health consequences will be enormous. We’ll see lower uptake, widening disparities, and greater vulnerability across the country.

The public shouldn’t be left to decide what’s medically safe and effective on their own accord. Not because people aren’t smart, but because they’re outmatched and easily influenced by marketing. That’s why we built agencies like the FDA — to evaluate evidence and shield patients from being misled. The system isn’t perfect, but it’s far better than outsourcing decisions to social media or profit-driven startups.

As for the COVID vaccine battle…

If you’re high-risk, your shot will likely still be covered.

If you’re not, you may face a bill.

And if you’re paying attention, you’ll see this fight isn’t really about safety at all. It’s about who controls the narrative — and whether “choice” in even the most basic of American healthcare means anything more than what you can afford.

Giddy up.

Alec Wade Ginsberg, PharmD, RPh
4th-Gen Pharmacist | Owner & COO, C.O. Bigelow
Founder, Drugstore Cowboy