In recent weeks, federal officials have rolled out new — and in some cases confusing or conflicting — information on who can and should get a COVID-19 vaccine this fall.

In late May, the head of the U.S. Food and Drug Administration suggested additional studies may be required before vaccinating healthy Americans under 65. Then, a leading Trump official, Robert F. Kennedy Jr., announced the U.S. Centers for Disease Control and Prevention would no longer recommend COVID vaccines for healthy children and pregnant women, bypassing the normal review by vaccine experts. 

Days later, the CDC contradicted part of the pronouncement, saying healthy children “may” get the shot. 

The back-and-forth has made it difficult for state and local health departments to keep track of what, exactly, the guidelines are for giving out the vaccine.

“I don’t have clear guidance from any regulatory body at this time,” said Dr. Prakash Ganesh, the medical director of the Cuyahoga County Board of Health.

Sudden change can be tough on local health departments, said Richard Stewart, a spokesperson for the Cleveland Department of Public Health. Guidelines set by the CDC are typically what local health departments use to advise patients and providers in their jurisdictions. Stewart said that’s especially the case when it comes to issues of national relevance like COVID vaccines. 

“It is a little disruptive psychologically to our department when directives come down somewhat unexpectedly,” Stewart said.

The Cleveland Department of Public Health stopped administering COVID vaccines at its clinics a year and a half ago because of low demand, so it is not directly impacted by the federal announcements, Stewart said. About 15% of Cuyahoga County’s population – around 183,000 individuals – received the updated vaccine shot since last September, according to the state of Ohio.

The Cuyahoga County Board of Health still gives out COVID shots, Ganesh said. 

As the whiplash continues, here’s what local and state leaders know about current guidelines for COVID vaccines. 

Have the new guidelines changed how COVID vaccines are being administered in Cuyahoga County yet?

Ganesh said Monday that on-the-ground practices for administering vaccines have not yet changed as a result of the federal back-and-forth. That’s because, in spite of federal pronouncements, CDC documents that lay out exactly how providers are supposed to administer vaccines have not yet changed, Ganesh said. These documents, called standing orders, share details about who exactly can get vaccinated. 

“They’ve announced these things, but they’re very vague,” Ganesh said of the federal announcements about changes to immunization schedules for healthy kids and pregnant women. “We need more specifics on what exactly is being recommended and how that’s going to change.”

But providers aren’t giving out many COVID vaccines at all right now because most prefer to do so in the fall, before respiratory illness season, Ganesh said. So the major questions local and state public health experts are asking is who will be able to get the shot later in the season. 

Under the new CDC guidance, can my child get the COVID vaccine?

All children over the age of six months are allowed to get the COVID vaccine if the healthcare provider and parent decide together that doing so makes sense, according to the new CDC guidelines. 

The change is that the CDC is no longer explicitly recommending that healthy children get the vaccine. 

Under the new CDC guidance, can pregnant people get the COVID vaccine?

This is less clear. The Ohio Department of Health said in a statement that it is “awaiting further clarity and guidance regarding the COVID-19 vaccine recommendation for pregnant women.”

Up until recently, the CDC recommended all people older than six months, including pregnant people, get the COVID vaccine. Now, pregnant women do not have any formal CDC recommendation regarding the COVID vaccine, according to the New York Times. 

Some healthcare providers, including Ganesh, worry that the cost of the vaccine may not be covered by insurance companies without an official recommendation by the CDC. 

What do the rules mean for federal free vaccine programs?

The Cuyahoga County Board of Health administers the federal Vaccines for Children program, which gives free vaccines to kids whose parents can’t afford them.

The Ohio Department of Health said the Vaccines for Children program will continue to provide COVID-19 shots under the new CDC guidance. 

The state said it had “not heard of any changes” with regards to a similar program for underinsured and uninsured adults. 

What will happen for the COVID vaccine rollout in the fall?

The ongoing uncertainty coming from the federal level makes it difficult to begin planning for the fall disbursement of COVID shots, Ganesh said. Historically, updated vaccines were released in the fall to specifically address the most prevalent strains of COVID. 

“We’re all not sure what’s going to happen and what is going to be recommended or if they’re even going to meet to discuss what the next vaccine would look like,” Ganesh said. 

He added that there are still unknowns about who will be able to get the shot in the fall, since the leader of the FDA has said more studies may be needed before approving a shot for healthy people under 65.