Four western states are issuing their own joint recommendations for who should receive Covid, flu and RSV vaccines this fall, providing a counterbalance in anticipation of new vaccine guidance from the Trump administration, which has purged prominent scientists from the federal health department and appointed vaccine skeptics and critics to key roles.
The new recommendations come as a recently fired director of the Centers for Disease Control and Prevention (CDC), Susan Monarez, testified to Congress that she feared that under Robert F Kennedy Jr, the Trump-appointed head of the Department of Health and Human Services, there was “a real risk that recommendations could be made restricting access to vaccines for children and others in need, without rigorous scientific review”.
The new guidelines from California, Oregon, Washington and Hawaii, which have formed what they call the West Coast Health Alliance, urge Americans to get this year’s Covid-19 vaccine if they are pregnant, age 65 or older, have a range of risk factors or simply “choose protection”. Very young children, from age 23 months to six, should also receive this year’s Covid vaccine, the states recommend, as should older children and teenagers who have risk factors or have not been vaccinated before.
“These recommendations represent a collaborative effort, done with humility and based on science, to meet our responsibilities to our communities and the public at large,” Dr Kenneth Fink, the director of Hawai’i’s department of health, said in a statement.
The western states’ recommendations contrast with the Trump administration’s current Covid-19 vaccine guidelines. In what experts called an unprecedented move, Kennedy, one of the US’s most prominent vaccine skeptics, announced in May that the federal government was no longer recommending that pregnant people and children receive the Covid-19 vaccine.
California, Washington and Oregon announced the West Coast Health Alliance in early September, shortly after the White House forced out Monarez, who had clashed with Kennedy over his efforts to reshape federal vaccine policies in ways that contradict established scientific research. Hawai’i has since joined the alliance.
In contrast with the acting head of Trump’s CDC, a former speechwriter and investment executive with no medical or scientific background, the state health officers who developed the new recommendations “are all medical doctors”, according to a statement from California governor Gavin Newsom. The recommendations are also based on guidance from major health associations, including the American Academy of Pediatrics.
The release of the western states’ winter vaccine recommendations come one day before a federal advisory committee on immunization is expected to meet to review current vaccine standards, potentially re-examining federal recommendations about which routine vaccinations children should receive, including standard vaccinations against hepatitis B and HPV (human papillomavirus).
Kennedy purged the existing members of the Advisory Committee on Immunization Practices (ACIP) in June, a move the head of one public health association called a “coup”, and replaced them with his own experts.
Even one Republican senator who is a medical doctor, Louisiana’s Bill Cassidy, has spoken out in concern about the risk of rescinding the recommendation for an infant hepatitis B vaccine, arguing that protecting newborns against the virus had been a tremendous success in making Americans healthier.
In late August, Cassidy issued a statement calling for a postponement of the ACIP meeting, which is scheduled to begin on Thursday, arguing: “If the meeting proceeds, any recommendations made should be rejected as lacking legitimacy given the seriousness of the allegations and the current turmoil in CDC leadership.”
Monarez, who served less than one month as the CDC director, warned in congressional testimony on Wednesday that Kennedy had told her in late August that “the childhood vaccine schedule would be changing starting in September, and I needed to be on board with it”, and said that he had subsequently fired her after she would not pledge to “commit in advance to approving every ACIP recommendation, regardless of the scientific evidence”, and because she resisted firing career public health officials responsible for vaccine policy without cause.
In response to questions about western states providing alternate vaccine guidelines, a spokesperson for Trump’s Department of Health and Human Services defended the ACIP committee, saying it “remains the scientific body guiding immunization recommendations in this country”, and that “HHS will ensure policy is based on rigorous evidence and Gold Standard Science, not the failed politics of the pandemic”.
“Democrat-run states that pushed unscientific school lockdowns, toddler mask mandates, and draconian vaccine passports during the COVID era completely eroded the American people’s trust in public health agencies,” the spokesperson said in a statement.
Although Trump officials have claimed that any adult who wants a Covid-19 vaccine will still be able to get one regardless of the federal guidelines, experts say this is “misleading”, and that federal guidelines profoundly shape how insurance companies reimburse the cost of vaccines and how pharmacies provide them, potentially creating serious practical and financial hurdles for Americans who still want to be vaccinated.
“If vaccine protections are weakened, preventable diseases will return,” Monarez testified on Wednesday.
Lauren Gambino, Madeleine Aggeler and Melody Schreiber contributed reporting
