\n<\/p>\n
Seven US states and the nation\u2019s largest city announced this week that they have formed the Northeast Public Health Collaborative, in an effort to strengthen the region\u2019s health guidance as the national health landscape fractures.<\/p>\n
As national health agencies revisit their recommendations, including high-profile restrictions on the updated Covid shots and the measles, mumps, rubella and varicella (MMRV) vaccine, the pressure is increasingly falling on states to navigate recommendations and new federal rules.<\/p>\n
\u201cI definitely see a future where there is considerable state-level variability on vaccine policy, much like we have seen in the abortion space,\u201d said Katelyn Jetelina, an epidemiologist and former senior adviser for the US Centers for Disease Control and Prevention (CDC).<\/p>\n
There were already some access issues with vaccines, especially for people who have been marginalized. \u201cBut in general, it didn\u2019t matter where you lived,\u201d said Jen Kates, senior vice-president at the health non-profit KFF. \u201cNow it does.\u201d<\/p>\n
And while Covid shots were the first to be restricted, policies could also change on other shots \u2013 as with the MMRV restrictions proposed on Thursday.<\/p>\n
\u201cThe area where it could really have a dramatic impact, is what might change with the kids\u2019 [routine vaccination schedule],\u201d Kates said.<\/p>\n
The new alliance \u2013 among Connecticut, Maine, Massachusetts, New Jersey, New York state and New York City, Pennsylvania and Rhode Island \u2013 has been collaborating for months, including a meeting in August to discuss emergency preparedness, vaccine purchasing, lab capacity and more.<\/p>\n
The West Coast Health <\/strong><\/em>Alliance, a similar organization led by the governors of Oregon, Washington, California and Hawaii, issued their first winter vaccine recommendation on Wednesday, encouraging residents to stay up to date on vaccines against Covid, flu and RSV.<\/p>\n In the past, the federal government funded much of the public health work done at state, local, territorial and tribal levels, and has worked as a \u201cnorm setter\u201d by offering the best available evidence and public health practices, Kates said.<\/p>\n The states would then make decisions on, for instance, which vaccines are required for school attendance and whether they offer non-medical exemptions.<\/p>\n States also regulate pharmacists, deciding whether a pharmacist can vaccinate someone without a prescription or administer vaccinations to kids. And states regulate a subset of health insurers operating within their jurisdictions.<\/p>\n Several states have laws that pharmacists can administer vaccines, and that insurers must cover them, when they\u2019re recommended by the Advisory Committee on Immunization Practices (ACIP).<\/p>\n Now, amid delays on recommendations and concerns that federal information may not be based on evidence or data, \u201cthey are scrambling to change their regulatory or information environments to be decoupled from the federal recommendation to the extent that they can\u201d, Kates said.<\/p>\n \u201cIt\u2019s a pretty dramatic thing. It\u2019s happened very quickly,\u201d Kates said. Several states have already moved to allow pharmacists to administer a Covid vaccine without a prescription and to require insurance coverage of the shots, and some have implemented broader language to potentially apply to other vaccines.<\/p>\n \u201cIt is going to create a very different environment, and it\u2019s already happening.\u201d<\/p>\n Other states are considering new restrictions to their vaccination policies. Florida\u2019s surgeon general, Joseph Ladapo, promised the state would soon end vaccine mandates for school attendance, though no law has been proposed to amend those mandates.<\/p>\n Idaho has the highest non-medical exemption rate in the country, and the state tried to pass a law earlier this year ending mandates, though that part of the law was ultimately removed.<\/p>\n West Virginia\u2019s senate passed a bill in February to expand non-medical exemptions, and Texas passed a bill making it easier to avoid vaccine mandates in May.<\/p>\n Some states, without changing any of their laws, might restrict access simply by \u201cfollowing exactly what FDA and CDC say\u201d, Kates said.<\/p>\n The result is a patchwork of vaccine rules varying by location \u2013 the divided states of America.<\/p>\n The fractures will not be felt equally even among states. Low-income people who don\u2019t have a strong relationship with doctors or private insurers will face more barriers to getting prescriptions and paying for shots, for example.<\/p>\n Medical organizations have also broken with official recommendations.<\/p>\n The American Academy of Pediatrics (AAP), for example, offers its own guidance on respiratory virus vaccination.<\/p>\n AHIP, the health insurance trade association, announced on Tuesday that members\u2019 health plans will \u201ccontinue to cover all ACIP-recommended immunizations that were recommended as of September 1, 2025\u201d. Not every major insurer is a member of AHIP.<\/p>\n States can help implement the recommendations of these professional organizations and try to clear roadblocks to access, Jetelina said.<\/p>\n By banding together, states can also share the work of examining scientific evidence and offering recommendations, as well as sharing potential bulk orders and making other collaborative actions.<\/p>\n But one state\u2019s policies can have repercussions for the entire nation.<\/p>\n \u201cInfectious diseases don\u2019t see state lines,\u201d Jetelina said. \u201cWhat happens in one state will directly impact people living in other states, especially those that cannot protect themselves because they are too young or too sick to get vaccinated.\u201d<\/p>\n The changes to vaccine recommendations are \u201cstressful\u201d, even for people who try to stay informed, and \u201cit contributes to this ecosystem of mistrust\u201d, Kates said.<\/p>\n \u201cAnd even for people who want to get a vaccine, the more obstacles that are put up \u2013 it\u2019s going to deter everybody.\u201d<\/p>\n While vaccine policy is shifting, vaccines remain overwhelmingly popular across the US.<\/p>\n The \u201cvast majority of Americans\u201d \u2013 between 80% and 90%, depending on the poll \u2013 still favor vaccination, though support has \u201cdramatically shifted\u201d along political lines in recent years, Jetelina said.<\/p>\n Even conservative parents in Florida, for example, support vaccines, according to a new KFF survey.<\/p>\n \u201cThey support mandates for going to school. They want their kids to be vaccinated,\u201d Kates said.<\/p>\n","protected":false},"excerpt":{"rendered":" Seven US states and the nation\u2019s largest city announced this week that they have formed the Northeast Public Health Collaborative, in an effort to strengthen the region\u2019s health guidance as the national health landscape fractures. 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