A disjointed map of vaccine guidance emerges 

States are beginning to take vaccine policies and recommendations into their own hands amid turmoil at the CDC, which could lead to a patchwork of varying approaches across the country and raise logistical questions for multi-state health systems. 

This year, changes to the vaccine landscape — particularly surrounding COVID-19 shots — led by HHS Secretary Robert F. Kennedy Jr. have given rise to a growing number of states working to issue their own guidance on vaccines. 

On Sept. 3, California, Oregon and Washington said they are forming an alliance to coordinate vaccine recommendations for their residents. Officials in the states said the West Coast Health Alliance will coordinate health guidelines to align with evidence-based recommendations by national medical organizations, including the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists. State leaders said the effort is intended to maintain access and trust in vaccine safety and efficacy, and is in response to what they called increasing politicization of the CDC.

“President Trump’s mass firing of CDC doctors and scientists — and his blatant politicization of the agency — is a direct assault on the health and safety of the American people,” Govs. Gavin Newsom, Tina Kotek and Bob Ferguson, of California, Oregon and Washington, respectively, said in a joint statement. “The CDC has become a political tool that increasingly peddles ideology instead of science, ideology that will lead to severe health consequences. California, Oregon and Washington will not allow the people of our states to be put at risk.”

Over the past week, the CDC has been roiled by major leadership shake‑ups. Susan Monarez, PhD, was ousted from her role as the agency’s director Aug. 27 after refusing to endorse “reckless directives” from Mr. Kennedy regarding vaccine policy changes and staff firings, her attorneys said. Four other senior CDC leaders also resigned. 

Health officials from eight states in the Northwest have also met in recent weeks to consider coordinating their own vaccine recommendations. Officials involved in that effort represent Connecticut, Maine, Massachusetts, New Jersey, New York, Pennsylvania, Rhode Island and Vermont, according to multiple reports.

Colorado on Sept. 3 issued a public health order to allow pharmacists to provide COVID vaccines without individual prescriptions. The order means that, effective Sept. 5, patients 6 months and older will be able to receive the vaccine without having to receive a prescription. 

The move came in response to the FDA’s recent decision to limit approvals for updated COVID shots to people at high risk of severe illness, including everyone aged 65 and older and younger individuals with at least one qualifying condition. The narrower criteria mean younger, healthy individuals may now need a prescription to get the vaccine. Medical and public health experts have said the decision will cause confusion and create new access hurdles, which could limit uptake and lead to strain on the nation’s healthcare system heading into respiratory virus season. 

Pharmacists in many states are now navigating new rules related to the administration of COVID shots. In 18 states and the District of Columbia, pharmacists’ authority to administer vaccines is tied to formal guidance from the CDC’s Advisory Committee on Immunization Practices, which Mr. Kennedy overhauled in June, firing all existing members and replacing them with handpicked members who have a history of anti-vaccine rhetoric. The committee is expected to meet in September to potentially vote on who should receive updated vaccines.

Absent formal ACIP guidance in the interim, questions remain surrounding pharmacists’ authority to administer vaccines in certain jurisdictions, even if they have them in stock. It’s also unclear whether health plans will fully cover vaccines not formally recommended by ACIP. Colorado’s new public health order requires the health department to work with the state’s insurance division to ensure vaccines are fully covered for Medicaid members. 

Meanwhile, officials in Florida said the state is planning to scrap all vaccine mandates, including routine immunization requirements for children entering kindergarten. The effort, led by Joseph Ladapo, MD, PhD, the state’s surgeon general who has questioned the safety and efficacy of mRNA vaccines, will require sign off by both the state’s department of health and the state legislature. 

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