* Wednesday…

The Food and Drug Administration on Wednesday approved updated COVID-19 vaccines for the upcoming fall/winter season for some Americans.

The Pfizer-BioNTech vaccine was approved for use in adults aged 65 and older and for those between ages 5 and 64 with at least one underlying condition that puts them at high risk for severe COVID.

* Thursday…

Health Secretary Robert F. Kennedy Jr. summoned Susan Monarez, the director of the Centers for Disease Control and Prevention, to his office in Washington earlier this week to deliver an ultimatum.

She needed to fire career agency officials and commit to backing his advisers if they recommended restricting access to proven vaccines — or risk being fired herself, according to people familiar with the events.

Dr. Monarez’s refusal to do so led to an extraordinary standoff on Thursday that paralyzed the nation’s health agency, which is still reeling from mass layoffs and a shooting this month that killed a police officer and terrified employees.

* Also yesterday…

CVS, the country’s largest pharmacy chain, is currently not offering Covid vaccines in 16 states, including Florida, New York and Pennsylvania, even to people who meet newly restricted criteria from the Food and Drug Administration.

Amy Thibault, a spokeswoman for CVS, cited “the current regulatory environment” as the reason the vaccine was not available in those states, or in the District of Columbia, emphasizing that the list could change. Legal experts said that federal decisions were creating an extremely difficult situation for pharmacies to navigate.

In some states, pharmacists are forbidden to administer vaccines that are not recommended by the Advisory Committee on Immunization Practices, a Centers for Disease Control and Prevention panel. […]

Those states are Arizona, Colorado, Florida, Georgia, Kentucky, Louisiana, Maine, Massachusetts, Nevada, New Mexico, New York, North Carolina, Pennsylvania, Utah, Virginia and West Virginia, along with the District of Columbia.

* Today…

Pritzker’s health department in Illinois is currently exploring the possibility of purchasing Covid-19 vaccines in bulk straight from manufacturers in response to the mess in Washington, a senior Illinois health official confirms to me. Meanwhile, a coalition of mostly-blue states led by Massachusetts Governor Maura Healey is planning to coordinate on the purchase and distribution of pediatric vaccines, should the federal government restrict access to them, according to a source familiar with ongoing discussions. This will likely include big states like New York and Pennsylvania. […]

Crucially, the narrowed FDA approval, which largely impacts the marketing of vaccines, doesn’t stop doctors from prescribing them “off label” to others who want them, [University of Michigan’s Sam Bagenstos, general counsel to the HHS under President Joe Biden] says. […]

“All that would have to happen is for some state to purchase a whole bunch of vaccines,” Bagenstos says, “then have the state’s chief health officer prescribe the vaccine to anyone who wants them—and then provide the vaccines out of the state’s own stock.” Or the state can provide them to doctors who would then prescribe them.

Something like this might happen with the aforementioned Illinois initiative exploring potential ways to buy the vaccine straight from manufacturers. “We have to build up an apparatus to shield us from the recklessness of Robert F. Kennedy,” a senior Illinois health official tells me.