Robert F. Kennedy Jr. clinched the political support needed to become the nation’s top health official by pledging to work within the decades-old federal system for approval and use of vaccines. Yet his regulators are promising big changes that cloud the outlook for what shots might even be available.

Regulators will soon “unleash a massive framework” for how vaccines are tested and approved, according to FDA Commissioner Marty Makary.

The vaccine will only be available to those at high risk from COVID—excluding those who may need it to protect a relative or friend.