States Plan to Diverge From CDC Panel on Covid Vaccine Guidance

Leaders across various states are planning to shift from their reliance on federal immunization recommendations for this fall’s respiratory virus season, citing Trump administration changes that depart from longstanding scientific review processes by medical professionals.

The leaders say they’re prepared to consider data and recommendations from other sources, including medical associations. The American Academy of Pediatrics and American College of Obstetricians and Gynecologists issued guidance this month promoting Covid-19 shots for healthy kids and pregnant women, challenging Health and Human Services Secretary Robert F. Kennedy Jr. ’s move earlier this year to pull federal recommendations for these populations.

The divergence signals a wariness by state lawmakers and public health experts of the HHS’ shift from traditional vaccine recommendation processes under Kennedy, who has replaced members of an influential vaccine panel at the US Centers for Disease Control and Prevention with people who have questioned the safety of vaccines.

Under Kennedy’s leadership, the Food and Drug Administration on Wednesday limited its approval of updated Covid vaccines to people 65 and older or who have underlying conditions, leaving out other populations previously eligible for boosters. CDC Director Susan Monarez was also ousted from the agency this week, reportedly after a confrontation on Monday with Kennedy in which she pushed back against his vaccine stance.

The uncertainty on what Covid shot guidance from the revamped Advisory Committee on Immunization Practices (ACIP) will look pushed Colorado, Massachusetts, and other states to tweak laws or introduce legislation allowing consideration of medical society guidance when developing school immunization requirements or other statewide vaccine policies.

State officials and public health professionals say the revisions are necessary to ensure recommendations are based on the latest available evidence on disease transmission and vaccine efficacy. For these public health leaders, the biggest challenge is working across state lines to continue to promote vaccination as one of the most effective tools at fighting infectious diseases.

“We’ve seen a change at the federal level that has moved away from the science to more of thinking about ideologies and individual positions,” said Charlotte Moser, co-director of the Vaccine Education Center at Children’s Hospital of Philadelphia.

“People need to be cautious and be paying attention to where their messages are coming from,” Moser said.

Federal Policy Shift

While ACIP recommendations are nonbinding, nearly 600 vaccination statutes and regulations across 49 states, three territories, and the District of Columbia, either require or suggest officials follow ACIP. These policies include mandatory school immunizations and insurance coverage.

The use of ACIP as a reference “has been because we’ve watched a transparent process at ACIP” and “really explored the recommendations that were made,” Massachusetts Department of Public Health Commissioner Robbie Goldstein said in an interview.

Now, there’s “really a whole new process that has been invented by the secretary,” Goldstein said of Kennedy.

HHS spokesperson Andrew Nixon said in an email that the recent recommendations from medical professional groups are “undermining national immunization policymaking.” He added that Kennedy has “stood firm in his commitment to science, transparency, and restoring public trust.”

States Step In

In Massachusetts, Gov. Maura Healey (D) proposed legislation to give the state health commissioner authority to examine available scientific data and evidence before making decisions about which vaccines to include in the state’s pediatric vaccine purchasing program and its school immunization requirements.

“If President Trump and Secretary Kennedy won’t protect people’s health—we will,” Healey said in an emailed statement.

Maine this year enacted similar legislation allowing the state’s vaccine board to consider other sources beyond ACIP when deciding which shots to include in its purchasing program. The bill’s sponsor, Rep. Sam Zager (D), is a physician and said in an interview the legislation is “a way to help protect Mainers from the effort at the federal level to sever ties with evidence-based vaccine policy.”

Colorado Gov. Jared Polis (D) in April signed legislation directing the state health department to consider recommendations from AAP, ACOG, and other health professional associations in addition to ACIP when developing disease control measures.

“If you look at those groups that are making these recommendations, they have a long history of science-based decisions and not politicizing public health,” Colorado state Rep. Lindsay Gilchrist (D), who sponsored the bill in the House, said in an interview. AAP has released its own recommendations since the 1930s.

Scott Harris, state health officer for the Alabama Department of Public Health, told reporters in an Aug.13 call that for any recommendations that come out of ACIP this fall, “we certainly want to see that scientific rationale behind” them, and “we want the ability to evaluate those ourselves.”

Interstate Collaboration

As states look at their own statutes and policies, health leaders are working across borders and communicating with insurers to guarantee Covid shots remain available, especially for kids and pregnant women.

“We want one unified voice across the country,” Gilchrist said. “The more that state legislatures, policy makers, public health professionals in states can share information and share policy approaches that can be collaborative, the better.”

Goldstein said he and other officials in Northeastern states formalized interstate communications since the start of President Donald Trump’s second term. Goldstein and leaders from Connecticut, Maine, New York, and surrounding states gathered in person last week to discuss potentially coordinating their vaccine recommendations.

“I’m hopeful that we don’t have individual state recommendations, but that we can align all together on recommendations that are evidence based,” he said.

Major health insurers, which typically follow ACIP recommendations when deciding which vaccines to cover, have committed to following the available scientific data. At the same time, Gilchrist said she is considering potential legislation to require insurers in Colorado to comply with the state’s vaccine’s recommendations.

As more states weigh how to move forward, Moser said the best option for patients who have questions on vaccinations continues to be speaking directly with their health provider.

“Their health-care providers are going to be monitoring all of this,” and “they already look at the science,” Moser said.