This story was updated at 4 p.m. on Friday, Sept. 12.
Adults in North Carolina who are between the ages of 18 and 65 with a high-risk condition can now receive a COVID-19 vaccine from their local pharmacy without a prescription.
On Friday afternoon, Gov. Stein and officials from the N.C. Department of Health and Human Services announced that they've issued a standing order to allow seniors and adults above 18 years old with an underlying condition to get the vaccine without a prescription.
"This is unnecessary red tape and it's time for North Carolina to get in line with other states across the country," Gov. Stein said at a press conference. "That's why I'm taking action to protect COVID-19 access for North Carolinians who'd like to get it — just like Virginia did two days ago."
Stein directed Dr. Larry Greenblatt, state health director and chief medical officer at N.C. DHHS, to issue the order if he agreed in his medical judgment. Adults with high-risk conditions can receive the vaccine from North Carolina pharmacies as soon as this weekend. According to the CDC, high-risk conditions can include heart conditions, diabetes, asthma and physical inactivity. The standing order did not lift the prescription requirement for children under the age of 18.
"We know that 70% of people in North Carolina received their COVID-19 vaccines at a pharmacy," said N.C. DHHS Secretary Dr. Dev Sangvai. " Vaccinations against seasonal respiratory viruses, including flu RSV, and COVID-19 are especially important for people who are at higher risk of severe viral respiratory disease. Vaccines are one of the most effective means available to prevent serious illness, hospitalization, and death."
In late August, the Food and Drug Administration approved new COVID-19 shots from Pfizer, Moderna and Novavax for this fall season, but imposed its most restrictive policy yet on who can receive them. For many children and adults younger than 65, only those with at least one underlying condition are eligible to receive a booster.
According to state law, pharmacists in North Carolina have to act in accordance with a CDC vaccine advisory panel's recommendations to administer vaccines. Typically, the CDC's Advisory Committee on Immunization Practices (ACIP) will issue guidelines that determine what vaccines adults and children can receive. Through a program called Vaccines for Children, the committee also determines which vaccines become available at no cost for children who are low-income or lack health insurance.
However, ACIP has not yet given its guidelines for the new COVID-19 shots. The agency in recent months has gone through tumultuous changes, which include Health Secretary Robert F. Kennedy Jr.'s dismissal of 17 of ACIP members and replacing several of them with vaccine skeptics. The committee would usually give its recommendations over the summer ahead of the fall immunization season, said Jay Campbell, executive director of the NC Board of Pharmacy. This year, ACIP will meet to discuss guidelines for several vaccines, including those for COVID-19, on Sept. 18 and 19.
"If ACIP meets and if it makes recommendations, those are required to be reviewed and accepted by the CDC director," Campbell wrote in an email. "But there is no director of CDC at present. I do not know whether someone is performing that role in any acting capacity or if there is a pathway for review and acceptance of ACIP recommendations by someone other than the director of the CDC. There may well be."
Prior to the standing order, North Carolina is one of a handful of states that required a prescription. Several state governors have acted to lift restrictions on COVID-19 vaccine accessibility, such as New York, which declared a "statewide disaster emergency" to ensure widespread access to the shots.
CVS MinuteClinics had served as the only places where people could access the new vaccines without an outside prescription. MinuteClinics are retail medical clinics and not pharmacies, so they do not follow pharmacy regulations and are overseen by the health department, said a CVS spokesperson in an email.
Most insurance plans will cover the cost of the new vaccines – without insurance, the shot costs $224.99. Also, in accordance with FDA policy, the provider at the MinuteClinic will likely inquire about preexisting conditions prior to administering the vaccine. And while MinuteClinics are generally available for walk-in visits, a CVS employee in the Triangle told WUNC that it's strongly encouraged to schedule appointments due to limited vaccine availability.
"Some clinics may have the updated 25-26 COVID vaccine but since the vaccine formulations were recently approved by FDA, it might not yet be available at all locations," a spokesperson for the NC Department of Health and Human Services wrote in an email.
The American Academy of Pediatrics and the American Academy of Family Physicians have released statements in recent weeks saying they recommend that children above six months of age and adults get vaccinated against COVID regardless of whether they have an underlying condition.
The most dominant COVID-19 variant that has been spreading in the U.S. is XFG, also called "Stratus." It was first detected in the U.S. in March, and now comprises more than three-quarters of COVID infections, according to the CDC. Symptoms of XFG are sore throat, cough, congestion, fever — similar to other variants.
The latest data on the NC Department of Health and Human Services COVID-19 dashboard shows that there's been a sharp increase in wastewater viral activity across the state in recent weeks and classifies the current levels as "very high."
